Results from SYNTAX Trial: Surgery Bests Stenting

Boston Scientific described results from the SYNTAX trial, comparing use of drug-eluting stents (DES) and coronary artery bypass grafting (CABG) after one year of follow-up. Data after one year indicates that CABG is the ideal method to treat those patients who are sickest, as reported by the Cardiovascular Business News.

More than 1,800 patients were recruited for the trial completed in the U.S. and Europe, with 85 participating hospitals. Two experts, a cardiac surgeon and interventional cardiologist, evaluated what treatment approach was warranted for each of the patients. Patients considered had either three-vessel or left main disease.

This is the first trial that includes a head-to-head comparison of CABG and percutaneous coronary intervention (PCI). After one year of follow-up, there were no statistically significant differences in either heart attack or risk of death. However, only 12.1 percent of patients who underwent bypass died compared to 17.8 percent of patients who had stents placed.

Based on these findings, data indicates that CABG is superior. However, the risk of stroke is higher among patients who had surgery; the risk was 2.2 percent for patients who had surgery and 0.6 percent for those who had stents placed. The rate of stroke among patients who had stents placed was significantly lower.

The patient population assessed in the trial had advanced disease and complex anatomy. The mean number of stents among patients was 4.6, while the overall average in everyday practice is 1.5, which Boston Scientific described in the press release detailing the study findings.

These findings validate the utility of stent placement among those patients who are not candidates for CABG. It should also compel clinicians to more often complete surgery rather than relying entirely on stenting.

September 8, 2008 Related topics: Quality, Safety, Errors

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