What's the Best Revascularization Procedure for Left Main Coronary Artery Disease?

Five-year SYNTAX results suggest that both PCI and CABG are valid options for many patients with this condition.

In the manufacturer-sponsored SYNTAX trial of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with complex coronary artery disease, 5-year outcomes were similar in both groups (NEJM JW Cardiol Mar 6 2013). Now, investigators report 5-year results in the subgroup of 705 patients with left main (LM) disease. Follow-up was available for over 92% of patients in both arms.

The rate of the combined safety endpoint (death, stroke, or myocardial infarction [MI]) was about 20% in both groups. Cardiac mortality was 8.6% with PCI and 7.2% with CABG — a nonsignificant difference. The between-group difference in major adverse cardiovascular and cerebrovascular events (MACCEs) — the composite of all-cause…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)