☆ 4.5 Article

Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery: fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS)

EUROINTERVENTION (2011)

Journal

EUROINTERVENTION

Volume 7, Issue 6, Pages 670-679

Publisher

EUROPA EDITION

DOI: 10.4244/EIJV7I6A109

Keywords

drug-eluting stent; bypass; angiography; left main disease; SYNTAX

Funding

Boston Scientific Corporation
Abbott
Atritech
Boston Scientific
Cardiac Dimensions
Edwards
Evalve
St. Jude

Ask authors/readers for more resources

Protocol

Community support

Reagent

Community support

Abstract

Aims: The SYNTAX-LE MANS substudy prospectively evaluated 15-month angiographic and clinical outcomes in patients with treated left main (LM) disease. Methods and results: In the SYNTAX trial, 1,800 patients with three-vessel and/or LM disease were randomised to either CABG or PCI; of these, 271 LM patients were prospectively assigned to receive a 15-month angiogram. The primary endpoint for the CABG arm was the ratio of >= 50% to <100% obstructed/occluded grafts bypassing LM lesions to the number placed. The primary endpoint for the PCI arm was the proportion of patients with <= 50% diameter stenosis ('patent' stents) of treated LM lesions. Per protocol, no formal comparison between CABG and PCI arms was intended based on the differing primary endpoints. Available 15-month angiograms were analysed for 114 CABG and 149 PCI patients. At 15 months, 9.9% (26/263) of CA BG grafts were 100% occluded and an additional 5.7% (15/263) were >= 50% to <100% occluded. Overall, 27.2% (31/114) of patients had 21 obstructed/occluded graft. The 15-month CABG MACCE rate was 8.8% (10/114) and MACCE at 15 months was not significantly associated with graft obstruction/occlusion (p=0.85). In the PCI arm, 92.4% (134/145) of patients had <= 50% diameter LM stenosis at 15 months (89.7% [87/97] distal LM lesions and 97.9% [47/48] non-distal LM lesions). The 15-month PCI MACCE rate was 12.8% (20/156) and this was significantly associated with lack of stent patency at 15 months (p<0.001), mainly due to repeat revascularisation. Conclusions: At 15 months, 15.6% (41/263) of grafts were at least 50% obstructed but this was not significantly associated with MACCE; 92.4% (134/145) of patients had stents that remained patent at 15 months, and stent restenosis was significantly associated with MACCE, predominantly due to revascularisation.

Authors

I am an author on this paper

Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.5

Not enough ratings

Secondary Ratings

Novelty

Significance

Scientific rigor

Rate this paper

Endoscopic vs Open Vein Harvest in Drug-Eluting Stents or Bypass Surgery for Left Main Disease Trial

Craig M. Jarrett, Marc Pelletier, Yasir Abu-Omar, Cristian Baeza, Yakov Elgudin, Alan Markowitz, Pablo Ruda Vega, Ovidiu Dressler, Arie Pieter Kappetein, Patrick W. Serruys, Gregg W. Stone, Joseph F. Sabik

Summary: The study compared the outcomes of coronary artery bypass grafting (CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH). The patients with different vein harvesting methods had different rates of ischemia-driven revascularization at 5 years. No significant differences were found in other endpoints, such as graft stenosis or occlusion, death, stroke, myocardial infarction, bleeding, blood product transfusion, major arrhythmia, and infection.

ANNALS OF THORACIC SURGERY (2023)