Coronary Artery Bypass Grafting better than Percutaneous Coronary Intervention for three vessel or left main coronary artery disease

The use of ‘Coronary Artery Bypass Grafting’ (CABG) rather than ‘Percutaneous Coronary Intervention’ (PCI) for the management of patients with triple vessel or left main coronary artery disease is associated with lower rates of major adverse cardiac or cerebrovascular events at 1 year. The conclusion is based on a trail (STNTAX trail) published in New England Journal of Medicine March 2009 edition.

The SYNTAX (Synergy between PCI with taxus and cardiac surgery) trail, conducted in United States and several countries in Europe, involved 1800 patients with previously untreated triple vessel disease or left main coronary artery disease. The patients were randomly assigned to undergo CABG or PCI and were monitored for the subsequent 12 month period for any major cardiac or cerebrovascular event. Death from any cause, stroke, myocardial infarction and repeat revascularization were considered as major adverse events. The research was sponsored by Boston Scientific, developer of the drug eluting taxus stent.

Research Findings
Rates of repeat revascularizations were higher in the PCI group compared to the CABG group (13.5% vs 5.9%).
Rates of death and myocardial infarction were similar in both PCI group and CABG group.
Rates of stroke was higher in the CABG group than the PCI group (2.2% vs 0.6%).
Rates of combined major adverse event was significantly higher in the PCI group than the CABG group (17.8% vs 12.8%)

Conclusion
CABG is better than PCI for patients with three vessel disease or left main coronary artery disease


Reference: New England Journal of Medicine, March 2009 edition

For details visit New England Journal of Medicine (NEJM) website (www.nejm.org)