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PCI yields low event rates vs. CABG in patients with lower SYNTAX score
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Coverage from the Transcatheter Cardiovascular Therapeutics (TCT) 2010 meeting
The 3-year results of the SYNTAX trial, according to data presented by Patrick W. Serruys, MD, PhD, suggested that percutaneous coronary intervention is a reasonable alternative to CABG for patients with left main disease with low and intermediate SYNTAX scores.
Serruys, of Erasmus Medical Center, the Netherlands, presented 3-year major adverse cardiac and cerebrovascular event (MACCE) data collected from a subgroup of patients who were assigned to PCI vs. CABG based on SYNTAX score.
According to the results, a SYNTAX score of less than 22 was associated with a numerically higher (although nonsignificant) cumulative MACCE rate in patients assigned to CABG vs. PCI (23% vs. 18%; P=.33). Further analyses revealed higher rates of stroke (4.1% vs. 0.9%), death (6% vs. 2.6%), and composite death/stroke/MI (11% vs. 6.9%) among patients assigned to CABG, but more MI (4.3% vs. 2%) and repeat revascularization (15.4% vs. 13.4%) in patients assigned PCI. None of the comparisons attained statistical significance.
Patients with an intermediate SYNTAX score of 23 to 32 had an identical MACCE rate of 23.4% at 3 years (P=.90). The researchers also reported a 12.4% mortality rate with CABG vs. 4.9% with PCI in this group (P=.06 for comparison), which Serruys said “surprised” the SYNTAX investigators. Stroke (2.3% vs. 1%) and composite death/stroke/MI (15.6% vs. 10.8%) were also higher in the CABG group vs. PCI; MI (5% vs. 3.3%) and repeat revascularization (15.9% vs. 14%) favored CABG. None of the comparisons reached statistical significance.
A SYNTAX score of more than 33 was associated with a MACCE rate of 37.3% with PCI vs. 21.2% with CABG (P=.003), however.
“There is a gap of 16 points in MACCE with PCI. There is no discussion here.” Serruys said.
In addition, the mortality rate of PCI was almost double that observed with CABG (13.4% vs. 7.6%). With the exception of stroke, patients undergoing PCI had higher rates of MI, repeat revascularization and composite death/stroke/MI.