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SYNTAX: CABG best for patients not qualified for stenting
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Researchers concluded that while stenting continues to improve, CABG remains the treatment option for at least a third of the patients screened in the SYNTAX trial.
Patrick Serruys, MD, head of interventional cardiology at Erasmus Medical Center, Rotterdam, The Netherlands, and Friedrich W. Mohr, MD, presented 12-month data from both the registry and randomized trial results here last month.
In the randomized arm, 897 patients were enrolled to undergo CABG and 903 PCI with the paclitaxel-eluting stent (Taxus, Boston Scientific). In the registry arm, 1,077 patients who did not qualify for the randomized trial underwent CABG and 198 stenting.
In the randomized arm of the trial, there was a significantly higher rate of revascularization among patients in the PCI group than among those in the CABG group (13.7 vs. 5.9) and a significantly higher rate of cerebrovascular incidents in the CABG group vs. PCI (2.2% vs. 0.6%). Major adverse CV or cerebrovascular events were higher in the PCI group vs. CABG (17.8 vs. 12.1%). This was due to an excess of redo revascularization among the PCI group, according to the presenters.
In the registry arm, all-cause death occurred among 2.5% of patients in the CABG registry and 7.3% in the PCI registry. Repeat revascularization occurred in 12% of the PCI registry vs. 3% in CABG. Major adverse CV or cerebrovascular events occurred in 20.4% of the PCI registry compared with 8.8% in the CABG registry. – by Judith Rusk
For more information:
- Serruys P, Mohr FW. Hotline II.
We as cardiologists are accused of being the gatekeeper, and I see it more like we have high responsibility ... The good news is that both techniques have improved. Success rates are very high, complication rates are very low. The doctors still needed to decide which is the best technique for the patient.
Symptomatic reperfusion and stent thrombosis, something we fear very much as cardiologists, all occurred at identical rates here in this study. How do you talk to your patient now? The take-home message from SYNTAX, in my point of view, is that we have to mention [revascularization] is still limiting PCI but we are doing better with drug-eluting stents. Doctor’s choice is the best.
– Christian Hamm, MD
Director, Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany