European Bifurcation Club 2008 – EBC 2008 – Prague, Czech Republic
LM stenting or surgery ?
LM stenting or surgery? Insights from Syntax Trial
Author: Patrick W. Serruys MD, PhD,
At the time of the trial design (in 2003-2004), a retrospective website survey of 104 medical centers over a period of 3 months showed that 12,072 patients (1/3 LM, 2/3 3VD) were revascularized by surgery (2/3) or by PCI (1/3).
The SYNTAX randomized trial is an attempt to provide an evidence-base to determine whether this approach, which is already currently practiced, is valid.
- In the randomized SYNTAX cohort, there were comparable overall safety outcomes (Death, CVA, MI,) in CABG and PCI patients at 12 months (7.7 vs. 7.6 %).
- There was a significantly higher rate of revascularization in the PCI group (13.7 vs. 5.9 %), and a significantly higher rate of CVA in the CABG group (2.2 vs. 0.6 %).
- Overall MACCE in the PCI group was higher (17.8 vs.12.1 %) due to an excess of redo revascularization compared with CABG.
- Per protocol rates of symptomatic graft occlusion and stent thrombosis were similar.
- The SYNTAX score will help stratify patients for the appropriate revascularization option.