Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial†
Why the study?
Does percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) improve outcomes in patients with left main and/or three-vessel coronary disease with or without diabetes?
Population
1800 patients with left main coronary disease and/or three-vessel disease, analyzed in subgroups with or…
Comparison
Percutaneous coronary intervention with… vs Coronary artery bypass grafting (CABG)
Design
RCT, randomized
Follow-up
5 years
Authors
Discussion
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Member takes
Implication
CABG should be preferred over PCI in diabetics with LM/3VD; confirms lower 5-year MACCE with surgery in this RCT.
Structured PICO
Does percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) improve outcomes in patients with left main and/or three-vessel coronary disease with or without diabetes?
P
Population
1800 patients with left main coronary disease (LM) and/or three-vessel disease (3VD), analyzed in subgroups with (n=452) or without (n=1348) diabetes.
I
Intervention
Percutaneous coronary intervention (PCI) with paclitaxel-eluting stents
C
Comparator
Coronary artery bypass grafting (CABG)
O
Outcome
Major adverse cardiac or cerebrovascular events (MACCE) at 5 yearscomposite
CABG remains the preferred revascularization strategy over PCI for patients with complex coronary artery disease (LM/3VD), especially in those with diabetes, due to lower 5-year rates of MACCE and repeat revascularization.
Cite This Study
Kappetein et al. (2013) studied this question.