ACP Journal Club. PCI was not as effective as CABG for severe coronary artery disease at 5 years.

Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Patients: 1800 patients (mean age 65 y, 78% men, mean SYNTAX score 28.7) who had de novo 3-vessel (3V) disease and/or left main coronary disease and were equally suitable for PCI or CABG. Exclusion criteria included previous PCI or CABG, persisting acute myocardial infarction (MI), or need for concomitant cardiac surgery. Intervention: PCI with paclitaxel-eluting stents and thienopyridine for ≥ 6 months plus aspirin (n = 903), or CABG (n = 897), with the intention of achieving complete revascularization. Minimally invasive direct CABG was not permitted. Patient follow-up: 93% (intention-to-treat analysis). Risks for MACCE; the composite of mortality, stroke, and MI; MI; and repeated revascularization were higher after PCI than after CABG (Table). Groups did not differ for mortality or stroke (Table). Conclusion In patients with severe coronary artery disease, percutaneous coronary intervention was not as effective as coronary artery bypass grafting for preventing major adverse cardiac and cerebrovascular events at 5 years. Stroke 2.4% 3.7% 39% (−8 to 65) Not significant †MACCE = major adverse cardiac and cerebrovascular events (mortality, stroke, myocardial infarction, or repeated revascularization); other abbreviations defined in Glossary. RRI, RRR, NNH, and NNT calculated from event rates and hazard ratios provided by author. Question In patients with severe coronary artery disease (CAD), what is the relative effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for preventing long-term major adverse cardiac and cerebrovascular events (MACCE)? Methods Design: Long-term follow-up of a randomized controlled trial (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery [SYNTAX] trial). ClinicalTrials.gov NCT00114972. Setting: 85 centers in the USA and Europe. with 3V CAD and low SYNTAX scores or left main disease and low or intermediate SYNTAX scores. Despite its usefulness, the SYNTAX score is only based on angio-graphic disease complexity and ignores potentially important clinical factors that affect outcome and treatment decisions. In response to these limitations, Farooq and colleagues derived and validated the new " SYNTAX score II, " which integrates the anatomical SYNTAX score and presence of unprotected left main disease with 6 empirically derived clinical variables into a nomogram that more accurately predicts 4-year mortality and comparative differences in mortality risk for patients having PCI or CABG. Despite the …