SYNTAX: DES, CABG Comparable in Left Main Disease

MIAMI BEACH, FLA.—The 4-year results of the SYNTAX trial presented by Ted Feldman, MD, indicate that revascularization with DES (Taxus, Boston Scientific) in patients with left main disease show similar safety and efficacy when compared with CABG. The researchers suggest that when the Syntax score is low or intermediate, PCI is a viable alternative treatment option in this patient population.

Feldman, of Evanston Hospital in Evanston, Ill., presented 4-year data on a subset of patients in the SYNTAX trial with left main disease assigned to either PCI (n= 357) or CABG (n= 348).

At 4 years, all cause death was similar in both groups.

The data indicate that overall MACCE also was comparable between the two groups, as were combined CVA, death and MI, while rates of repeat revascularization were higher with PCI (see Table).

A higher rate for CVA was observed among those assigned to CABG (4.3%) vs. those assigned to PCI (1.5%). New events were more common among those with high Syntax scores.

“This is borderline, but very sobering and a very striking difference was observed,” Feldman said. “Overall, MACCE in the PCI group was comparable with CABG at 4 years. PCI outcomes are excellent relevant to CABG, especially in the left main isolated and left main single-vessel disease patients.”

Stent thrombosis data: 5-year results

Patrick W. Serruys, MD, PhD, of Erasmus Medical Center, the Netherlands, presented 5-year results on stent thrombosis in the SYNTAX cohort with left main disease. 

According to the results, rates of symptomatic, per protocol ST per patient and per stent were slightly increased when compared with graft occlusion. At 5 years, the binary per-patient rates for graft occlusion were 5.5% and 6.6% for ST. Analyzed per graft/per-stent, the binary rates for graft occlusion were 2% and 1.8% for ST.

Compared with most graft occlusion events that occurred between 30 days and 1 year, most ST events occurred before 30 days. ST and graft occlusion events continued after 2 years.

Patients who experienced ST were more likely to have serious complications when compared with those who experienced graft occlusion. Mortality occurred in about one-third of patients after ST. When compared with 34% of patients assigned to PCI, 66% of patients assigned to CABG experienced repeat revascularization following ST or graft occlusion were not influenced by Syntax scores.

“The rate of symptomatic protocol ST was somewhat higher than graft occlusion per patient and stent,” Serruys said.