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SYNTAXES: DES, CABG confer comparable 10-year survival

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Daniel J.F.M. Thuijs

SAN DIEGO — In preliminary 10-year results of the SYNTAXES study presented at TCT 2018, there was no significant difference in survival between patients who had CABG and those who had PCI with a first-generation drug-eluting stent.

However, CABG was associated with better 10-year survival in patients with three-vessel disease, Daniel J.F.M. Thuijs, MD, MSc, PhD fellow from the department of cardiothoracic surgery at Erasmus Medical Center in Rotterdam, the Netherlands, said during a press conference.

The researchers included the previously enrolled 1,800 patients (mean age, 65 years) from the original SYNTAX trial with three-vessel CAD or left main disease to undergo CABG or PCI with a first-generation paclitaxel-eluting stent (Taxus, Boston Scientific). The primary outcome of the SYNTAXES study was all-cause death at 10 years. Thuijs presented 10-year data from 72.3% of the cohort.

The primary outcome occurred in 29.4% of the PCI group vs. 25.6% of the CABG group (HR = 1.17; 95% CI, 0.96-1.42), Thuijs said during the press conference.

The results were consistent with 5-year mortality results in this population, he said.

However, among those who had three-vessel CAD, the PCI group had significantly higher 10-year mortality (29.2% vs. 21.9%; HR = 1.43; 95% CI, 1.1-1.85), Thuijs said.

“In the patients with three-vessel disease, we can see there is a clear survival benefit of CABG over PCI,” he said during the press conference.

In the cohort of patients with left main disease, there was no difference between the approaches in 10-year mortality (PCI, 29.7%; CABG, 31.9%; HR = 0.89; 95% CI, 0.66-1.19), according to Thuijs.

“The survival lines were almost equal, and PCI and CABG performed almost equally well at 10-year follow-up,” he said.

In the overall cohort and in patients with three-vessel disease, those with a SYNTAX score of 33 or more had better results with CABG, but those with a SYNTAX score of 32 or less had similar results with either approach (P for interaction for overall cohort = .05; P for interaction for three-vessel disease = .054), according to the researchers.

“There is a stepwise increase in mortality when the SYNTAX score increases in favor of CABG,” Thuijs said during the press conference. “If there is more complex coronary artery disease, it is in favor of CABG. For three-vessel disease, we can also see the same stepwise increase in mortality according to the increase in SYNTAX score. In the left main disease patients, this stepwise increase is not there.”

The results support U.S. and European guidelines recommending CABG for patients with complex disease and for CABG or PCI in patients with less complex disease, he said.

“The delivery of care is CABG for patients with complex three-vessel disease and high SYNTAX scores, and PCI for patients with left main disease and less complex three-vessel disease,” Thuijs said. – by Erik Swain

Reference:

Thuijs DJFM, et al. Late-Breaking Clinical Science 2. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.

Disclosure: Thuijs reports no relevant financial disclosures.