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Best way to revascularize patients with main stem and three vessel lesions: patients should undergo PCI!

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Abstract

The optimal revascularization strategy for multivessel disease is under controversial discussion for long time. Until now, technical innovations have been faster than performance of clinical trials, making results of randomized studies outdated at the time of appearance. Recently, the SYNTAX trial has been published, which compared drug elutings stents (DES) implantation with Coronary artery bypass graft (CABG) patients with multivessel or left main disease in a clinically stable population. Overall, CABG was superior with respect to the clinical endpoint of death, myocardial infarction, stroke, or revascularization. However, the difference is driven by the “weakest” end point, namely repeated revascularization, whereas combined “hard” events did not demonstrate a difference. More detailed analysis demonstrates that only patients with most complex coronary anatomy gain definite benefit from CABG. In addition, SYNTAX demonstrated that left main disease is no longer a domain of CABG, since DES implantation revealed comparable results, as long as there is no concomitant multivessel disease. Regardless the results of SYNTAX, one should not forget that SYNTAX represents only a minority of daily patients in a catheterization laboratory, excluding patients with one- or two-vessel disease and those with an acute coronary syndrome. Especially in the latter, percutaneous coronary intervention has demonstrated to improve prognosis.

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Authors and Affiliations

  1. Klinikum Fulda, Department of Medicine I, Cardiology, Fulda, Germany

    Volker Schächinger

  2. Paracelsus-Krankenhaus Ruit, Ostfildern, Germany

    Christian Herdeg

  3. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany

    Bruno Scheller

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  1. Volker Schächinger
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Correspondence to Bruno Scheller.

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Schächinger, V., Herdeg, C. & Scheller, B. Best way to revascularize patients with main stem and three vessel lesions: patients should undergo PCI!. Clin Res Cardiol 99, 531–539 (2010). https://doi.org/10.1007/s00392-010-0189-8

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