Bypass Grafting Proves Superior to PCI in Severe Coronary Artery Disease

Bypass grafting "remains the standard of care" in severe coronary disease, according to a New England Journal of Medicine study.

20 feb 2009--SYNTAX trial researchers randomized 1800 patients with three-vessel or left main coronary artery disease either to CABG or PCI with drug-eluting stents. Participants were from 85 centers in Europe and the U.S. (A stent manufacturer paid for and participated in the study.)

By the 12-month mark, more patients undergoing PCI experienced major cardiac and cardiovascular adverse events, including death from any cause, than did those undergoing CABG. However, stroke was more likely after CABG. The authors conclude that "CABG proved to be superior."

Writing in Journal Watch Cardiology, Howard Herrmann suggests that, in deciding which approach to use, "the newly defined SYNTAX score (measuring lesion complexity based on angiograms) used in both the randomized trial and a registry of excluded patients could help inform clinical decision making."

LINK(S):

NEJM article (Free)

NEJM editorial (Free)