For 3-vessel disease (but not left main disease), CABG is preferred over PCI

Reference

Thuijs DJ, Kappetein AP, Serruys PW, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet 2019;394(10206):1325-1334.

Synopsis

This is the 10-year follow-up to a trial that initially randomized 1800 patients with 3-vessel coronary artery disease or left main disease to receive either PCI with a drug-eluting stent or CABG. Groups were balanced at the beginning of the trial and analysis was by intention to treat. The average age of participants was 65 years, 25% had diabetes, 33% had a previous myocardial infarction, and 9% had a previous stroke or transient ischemic attack. Left main disease was present in 40% and 3-vessel disease in 60% of the patients. The primary outcome was all-cause mortality, ascertained primarily from national death registries. Median follow-up was 11.2 years. At 10 years, 27% of patients in the PCI group had died compared with 24% in the CABG group (hazard ratio [HR] 1.17; 95% CI 0.97 - 1.41). Analyzing the period from 5 years to 10 years separately, the authors again found no significant difference (13% for PCI vs 12% for CABG). There was a difference between groups based on their initial lesion. In those with 3-vessel disease all-cause mortality was significantly higher in the PCI group (28% vs 21%; HR 1.41; 1.10 - 1.80), while there was no difference in mortality for those with left main disease (26% for PCI vs 28% for CABG). Results were similar for patients with and without diabetes.