Five-Year Outcomes in Patients with Left Main Disease Treated with Either Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting in the SYNTAX Trial.

This manuscript reports on the 5-year outcomes in the 705 patients with left main (LM) lesions enrolled in the randomized arm of the SYNTAX trial. Follow-up data to 5 years were available in 96.9% of patients who underwent PCI and 92.5% of patients randomized to CABG. Total MACCE at 5 years was 36.9% in patients who received PCI compared with 31.0% in CABG patients (hazard ratio 1.23 [0.95, 1.59]; P=0.12) which was mainly related to differences in repeat revascularization. In the group of patients with high SYNTAX Scores (≥33), MACCE, as well as cardiac death, and revascularization were all significantly increased in patients receiving PCI; whereas stroke and MI occurred at similar rates between treatment arms. The findings suggest that PCI can provide equivalent long-term (to 5 years) death/stroke or MI to CABG, in particular in the subset of LM subjects with SYNTAX Scores <33.