Title : Outcome of percutaneous coronary intervention versus coronary artery bypass grafting for patients with intermediate SYNTAX II score
Abstract:
Background:
Patients with intermediate SYNTAX II score have been representing a confusion in our daily practice for interventional cardiologists whether to treat them by percutaneous coronary intervention (PCI) using second generation drug eluting stents or by coronary artery bypass grafting (CABG)
Methods:
We enrolled 214 consecutive patients with intermediate SYNTAX II score to undergo revascularization (109 patients underwent PCI and 105 patients underwent CABG) after Heart Team discussion. Using a wide range of noninferiority margin, we compared both procedures with respect to the primary composite end point of major adverse cardiac or cerebrovascular events (all-cause mortality, myocardial infarction, target vessel revascularization or stroke) at 40 months post procedure.
Results:
At 40 months post revascularization procedure, the primary end-point occurred in 22 patients and 15 patients in the PCI and CABG groups, respectively (hazard ratio, 1.65; 95% confidence interval, 0.87 to 3.14; P = 0.13 for noninferiority). No significant differences were detected between both groups regarding the composite incidence of all-cause mortality, myocardial infarction, target vessel revascularization and stroke. CABG significantly provided better quality of life than PCI for patients with intermediate SYNTAX II score
Conclusion:
In patients with intermediate SYNTAX II score, PCI using second generation drug eluting stents was not noninferior to CABG with respect to the incidence of MACCE at 40 months post revascularization procedure.
Audience Take Away:
• To our knowledge, this is the only study which included only patients with intermediate SYNTAX II score, excluding low and high SYTNAX II scores
• The aim was to solve the puzzle in our daily practice and answering a daily asked question by the cardiologists, the patient and his family ‘Is treating the patient via PCI using newer generations of drug eluting stents is a better option than a more invasive procedure by sending him to surgery?’
• When and how to choose the best revascularization option
• How to share all the information with the patient and his family to decide the best option
