Five-Year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial

Marie Claude Morice, Patrick W. Serruys, A. Pieter Kappetein, Ted E. Feldman, Elisabeth Ståhle, Antonio Colombo, Michael J. Mack, David R. Holmes, James W. Choi, Witold Ruzyllo, Grzegorz Religa, Jian Huang, Kristine Roy, Keith D. Dawkins, Friedrich Mohr

Research output: Contribution to journalArticle

242 Citations (Scopus)

Abstract

Background-Current guidelines recommend coronary artery bypass graft surgery (CABG) when treating significant de novo left main coronary artery (LM) stenosis; however, percutaneous coronary intervention (PCI) has a class IIa indication for unprotected LM disease in selected patients. This analysis compares 5-year clinical outcomes in PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, the largest trial in this group to date. Methods and Results-The SYNTAX trial randomly assigned 1800 patients with LM or 3-vessel disease to receive either PCI (with TAXUS Express paclitaxel-eluting stents) or CABG. The unprotected LM cohort (N=705) was predefined and powered. Major adverse cardiac and cerebrovascular event rates at 5 years was 36.9% in PCI patients and 31.0% in CABG patients (hazard ratio, 1.23 [95% confidence interval, 0.95-1.59]; P=0.12). Mortality rate was 12.8% and 14.6% in PCI and CABG patients, respectively (hazard ratio, 0.88 [95% confidence interval, 0.58-1.32]; P=0.53). Stroke was significantly increased in the CABG group (PCI 1.5% versus CABG 4.3%; hazard ratio, 0.33 [95% confidence interval, 0.12-0.92]; P=0.03) and repeat revascularization in the PCI arm (26.7% versus 15.5%; hazard ratio, 1.82 [95% confidence interval, 1.28-2.57]; P

Original languageEnglish
Pages (from-to)2388-2394
Number of pages7
JournalCirculation
Volume129
Issue number23
DOIs
Publication statusPublished - Jun 10 2014

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Taxus
Percutaneous Coronary Intervention
Coronary Artery Bypass
Thoracic Surgery
Transplants
Confidence Intervals
Coronary Stenosis
Paclitaxel
Stents
Arm
Stroke
Guidelines
Mortality

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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Five-Year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. / Morice, Marie Claude; Serruys, Patrick W.; Kappetein, A. Pieter; Feldman, Ted E.; Ståhle, Elisabeth; Colombo, Antonio; Mack, Michael J.; Holmes, David R.; Choi, James W.; Ruzyllo, Witold; Religa, Grzegorz; Huang, Jian; Roy, Kristine; Dawkins, Keith D.; Mohr, Friedrich.

In: Circulation, Vol. 129, No. 23, 10.06.2014, p. 2388-2394.

Research output: Contribution to journalArticle

Morice, MC, Serruys, PW, Kappetein, AP, Feldman, TE, Ståhle, E, Colombo, A, Mack, MJ, Holmes, DR, Choi, JW, Ruzyllo, W, Religa, G, Huang, J, Roy, K, Dawkins, KD & Mohr, F 2014, 'Five-Year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial', Circulation, vol. 129, no. 23, pp. 2388-2394. https://doi.org/10.1161/CIRCULATIONAHA.113.006689
Morice, Marie Claude ; Serruys, Patrick W. ; Kappetein, A. Pieter ; Feldman, Ted E. ; Ståhle, Elisabeth ; Colombo, Antonio ; Mack, Michael J. ; Holmes, David R. ; Choi, James W. ; Ruzyllo, Witold ; Religa, Grzegorz ; Huang, Jian ; Roy, Kristine ; Dawkins, Keith D. ; Mohr, Friedrich. / Five-Year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. In: Circulation. 2014 ; Vol. 129, No. 23. pp. 2388-2394.
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abstract = "Background-Current guidelines recommend coronary artery bypass graft surgery (CABG) when treating significant de novo left main coronary artery (LM) stenosis; however, percutaneous coronary intervention (PCI) has a class IIa indication for unprotected LM disease in selected patients. This analysis compares 5-year clinical outcomes in PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, the largest trial in this group to date. Methods and Results-The SYNTAX trial randomly assigned 1800 patients with LM or 3-vessel disease to receive either PCI (with TAXUS Express paclitaxel-eluting stents) or CABG. The unprotected LM cohort (N=705) was predefined and powered. Major adverse cardiac and cerebrovascular event rates at 5 years was 36.9{\%} in PCI patients and 31.0{\%} in CABG patients (hazard ratio, 1.23 [95{\%} confidence interval, 0.95-1.59]; P=0.12). Mortality rate was 12.8{\%} and 14.6{\%} in PCI and CABG patients, respectively (hazard ratio, 0.88 [95{\%} confidence interval, 0.58-1.32]; P=0.53). Stroke was significantly increased in the CABG group (PCI 1.5{\%} versus CABG 4.3{\%}; hazard ratio, 0.33 [95{\%} confidence interval, 0.12-0.92]; P=0.03) and repeat revascularization in the PCI arm (26.7{\%} versus 15.5{\%}; hazard ratio, 1.82 [95{\%} confidence interval, 1.28-2.57]; P",
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T1 - Five-Year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial

AU - Morice, Marie Claude

AU - Serruys, Patrick W.

AU - Kappetein, A. Pieter

AU - Feldman, Ted E.

AU - Ståhle, Elisabeth

AU - Colombo, Antonio

AU - Mack, Michael J.

AU - Holmes, David R.

AU - Choi, James W.

AU - Ruzyllo, Witold

AU - Religa, Grzegorz

AU - Huang, Jian

AU - Roy, Kristine

AU - Dawkins, Keith D.

AU - Mohr, Friedrich

PY - 2014/6/10

Y1 - 2014/6/10

N2 - Background-Current guidelines recommend coronary artery bypass graft surgery (CABG) when treating significant de novo left main coronary artery (LM) stenosis; however, percutaneous coronary intervention (PCI) has a class IIa indication for unprotected LM disease in selected patients. This analysis compares 5-year clinical outcomes in PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, the largest trial in this group to date. Methods and Results-The SYNTAX trial randomly assigned 1800 patients with LM or 3-vessel disease to receive either PCI (with TAXUS Express paclitaxel-eluting stents) or CABG. The unprotected LM cohort (N=705) was predefined and powered. Major adverse cardiac and cerebrovascular event rates at 5 years was 36.9% in PCI patients and 31.0% in CABG patients (hazard ratio, 1.23 [95% confidence interval, 0.95-1.59]; P=0.12). Mortality rate was 12.8% and 14.6% in PCI and CABG patients, respectively (hazard ratio, 0.88 [95% confidence interval, 0.58-1.32]; P=0.53). Stroke was significantly increased in the CABG group (PCI 1.5% versus CABG 4.3%; hazard ratio, 0.33 [95% confidence interval, 0.12-0.92]; P=0.03) and repeat revascularization in the PCI arm (26.7% versus 15.5%; hazard ratio, 1.82 [95% confidence interval, 1.28-2.57]; P

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