Article (Scientific journals)
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Thuijs, Daniel J. F. M.; Kappetein, A. Pieter; Serruys, Patrick W. et al.
2019In Lancet (London, England), 394 (10206), p. 1325-1334
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Keywords :
Aged; Coronary Artery Bypass; Coronary Artery Disease/mortality/pathology/surgery; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Survival Rate; Treatment Outcome
Abstract :
[en] BACKGROUND: The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease, and reported results up to 5 years. We now report 10-year all-cause death results. METHODS: The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to the PCI group or CABG group. Patients with a history of PCI or CABG, acute myocardial infarction, or an indication for concomitant cardiac surgery were excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause death, which was assessed according to the intention-to-treat principle. Prespecified subgroup analyses were performed according to the presence or absence of left main coronary artery disease and diabetes, and according to coronary complexity defined by core laboratory SYNTAX score tertiles. This study is registered with ClinicalTrials.gov, NCT03417050. FINDINGS: From March, 2005, to April, 2007, 1800 patients were randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status information at 10 years was complete for 841 (93%) patients in the PCI group and 848 (95%) patients in the CABG group. At 10 years, 244 (27%) patients had died after PCI and 211 (24%) after CABG (hazard ratio 1.17 [95% CI 0.97-1.41], p=0.092). Among patients with three-vessel disease, 151 (28%) of 546 had died after PCI versus 113 (21%) of 549 after CABG (hazard ratio 1.41 [95% CI 1.10-1.80]), and among patients with left main coronary artery disease, 93 (26%) of 357 had died after PCI versus 98 (28%) of 348 after CABG (0.90 [0.68-1.20], pinteraction=0.019). There was no treatment-by-subgroup interaction with diabetes (pinteraction=0.66) and no linear trend across SYNTAX score tertiles (ptrend=0.30). INTERPRETATION: At 10 years, no significant difference existed in all-cause death between PCI using first-generation paclitaxel-eluting stents and CABG. However, CABG provided a significant survival benefit in patients with three-vessel disease, but not in patients with left main coronary artery disease. FUNDING: German Foundation of Heart Research (SYNTAXES study, 5-10-year follow-up) and Boston Scientific Corporation (SYNTAX study, 0-5-year follow-up).
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Thuijs, Daniel J. F. M.
Kappetein, A. Pieter
Serruys, Patrick W.
Mohr, Friedrich-Wilhelm
Morice, Marie-Claude
Mack, Michael J.
Holmes, David R. Jr
Curzen, Nick
Davierwala, Piroze
Noack, Thilo
Milojevic, Milan
Dawkins, Keith D.
da Costa, Bruno R.
Juni, Peter
Head, Stuart J.
More authors (5 more) Less
Other collaborator :
Casselman, Filip
de Bruyne, Bernard
Christiansen, Evald Hoj
Riuz-Nodar, Juan M
Vermeersch, Paul
Schultz, Werner
Sabate, Manel
Guagliumi, Giulio
Grubitzsch, Herko
Stangl, Karl
Darremont, Olivier
Bentala, M
den Heijer, Peter
Preda, Istvan
Stoler, Robert
Mack, Michael
Szerafin, Tamas
Buckner, John
Guber, Myles
Verberkmoes, Niels
Akca, ferdi
Feldman, Ted
Beyersdorf, Friedhelm
Drieghe, Benny
Oldroyd, Keith
Berg, Geoff
Jeppsson, Anders
Barber, Kimberly
Wolschleger, Kevin
Heiser, John
van der Harst, Pim
Mariani, Massimo
Reichenspurner, Hermann
Stark, Christoffer
Laine, Mika
Ho, Paul
Chen, John
Zelman, Richard
Horwitz, Phillip
Bochenek, Andrzef
Krauze, Agata
Grothusen, Christina
Dudek, Dariusz
Heyrich, George
Davierwala, Piroze
Noack, Thilo
Kolh, Philippe  ;  Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et path.
Legrand, Victor ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Coelho, Pedro
Ensminger, Stephan
Nasseri, Boris
Ingemansson, Richard
Olivecrona, Goran
Escaned, Javier
Guera, Reddy
Berti, Sergio
Morice, Marie-Claude
Chieffo, Alaide
Burke, Nicholas
Mooney, Michael
Spolaor, Alvise
Hagl, Christian
Näbauer, Michael
Suttorp, Maarten Jan
Stine, Ronald
McGarry, Thomas
Lucas, Scott
Endresen, Knut
Taussig, Andrew
Accola, Kevin
Canosi, Umberto
Horvath, Ivan
Cannon, Louis
Talbott, John
Akins, Chris
Kramer, Robert
Aschermann, Michael
Killinger, William
Narbute, Inga
Holmes, David
Burzotta, Francesco
Bogers, Ad
Zijstra, Felix
Eltchaninoff, Hélène
Berland, Jacques
Stefanini, Giulio
Gonzalez, Ignacio Cruz
Hoppe, Uta
Kiesz, Stefan
Gora, Bartlomiej
Ahlsson, Anders
Corbascio, Matthias
Bilfinger, Thomas
Carrie, Didier
Tchétché, Didier
Hauptman, Karl-Eugen
Stahle, Elisabeth
James, Stefan
Sandner, Sigrid
Laufer, Günther
Lang, Irene
Witkowski, Adam
Thourani, Vinod
Suryapranata, Harry
Redwood, Simon
Knight, Charles
MacCarthy, Philip
Curzen, Nick
de Belder, Adam
Banning, Adrian
Gershlick, Anthony
More authors (101 more) Less
Language :
English
Title :
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Publication date :
2019
Journal title :
Lancet (London, England)
ISSN :
0140-6736
eISSN :
1474-547X
Publisher :
Elsevier
Volume :
394
Issue :
10206
Pages :
1325-1334
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright (c) 2019 Elsevier Ltd. All rights reserved.
Available on ORBi :
since 29 August 2020

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