SYNTAX
Synergy Between PCI with Taxus and Cardiac Surgery
Clinical Question
Population
Patients with previously untreated three-vessel or left main coronary artery disease deemed suitable for either PCI or CABG by a Heart Team.
PCI with first-generation paclitaxel-eluting stents (TAXUS Express)
Coronary artery bypass grafting (CABG)
Primary Endpoint
Major adverse cardiac and cerebrovascular events (MACCE): death, stroke, myocardial infarction, or repeat revascularization at 12 months
Key Findings
PCI did not meet noninferiority: 12-month MACCE was 17.8% in PCI vs 12.4% in CABG (p=0.002 for superiority of CABG).
The difference was driven primarily by higher repeat revascularization rates with PCI (13.5% vs 5.9%).
In patients with low SYNTAX scores (0-22), outcomes were similar between PCI and CABG.
At 5 years, MACCE was 37.3% with PCI vs 26.9% with CABG, with higher mortality in PCI for three-vessel disease (p=0.02).
The SYNTAX score emerged as a validated anatomical scoring tool to guide revascularization decisions.
Impact on Clinical Practice
Guideline Impact
Limitations
First-generation drug-eluting stents were used; newer-generation stents have lower restenosis and thrombosis rates, potentially narrowing the gap.
The SYNTAX score does not account for clinical variables such as diabetes, left ventricular function, or patient frailty.
The open-label design may have introduced bias in the management of postprocedural care and event adjudication.
How Does This Trial Apply to Your Case?
Clinical trials inform guidelines, but every patient is unique. Our Heart Team evaluates how landmark evidence applies to your specific anatomy, risk profile, and preferences.
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