The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: Design, rationale, and run-in phase

Recent years have seen an ongoing debate as to whether coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) is the most appropriate revascularisation strategy for patients with coronary heart disease (CAD). The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) study was conducted with the intention of defining the specific roles of each therapy in the management of de novo three-vessel disease or left main CAD. Interim results after 12 months show that PCI leads to significantly higher rates of major adverse cardiac or cerebrovascular events compared with CABG (17.8 versus 12.4; p=0.002), largely owing to increased rates of repeat revascularisation. However, CABG was much more likely to lead to stroke. Interestingly, categorisation of patients by severity of CAD complexity according to the SYNTAX score has shown that there are certain patients in whom PCI can yield results that are comparable to, if not better than, those achieved with CABG. Careful clinical evaluation and comprehensive assessment of CAD severity, alongside application of the SYNTAX score, can aid practitioners in selecting the most suitable therapy for each individual CAD patient.

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Global Risk Classification and Clinical SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) Score in Patients Undergoing Percutaneous or Surgical Left Main Revascularization

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2010.10.013 ◽

2011 ◽

Vol 4 (3) ◽

pp. 287-297 ◽

Cited By ~ 93

Author(s):

Davide Capodanno ◽

Anna Caggegi ◽

Marco Miano ◽

Glauco Cincotta ◽

Fabio Dipasqua ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Surgery ◽

Coronary Intervention ◽

Risk Classification ◽

Global Risk ◽

Left Main ◽

Percutaneous Coronary

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Current state of the performance of percutaneous coronary intervention in centres without on-site cardiac surgery

Internal Medicine Journal ◽

10.1111/j.1445-5994.2012.02898.x ◽

2012 ◽

Vol 42 ◽

pp. 58-67

Author(s):

E. Oqueli

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Surgery ◽

Coronary Intervention ◽

Current State ◽

Percutaneous Coronary

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Risk reduction strategies: coronary revascularization before non-cardiac surgery

ESC CardioMed ◽

10.1093/med/9780198784906.003.0639 ◽

2018 ◽

pp. 2659-2663

Author(s):

Fabio Rigamonti ◽

Marco Roffi

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Surgery ◽

Myocardial Revascularization ◽

Bare Metal Stents ◽

Coronary Intervention ◽

Drug Eluting Stent ◽

Metal Stents ◽

Percutaneous Coronary ◽

Reduction Strategies ◽

Drug Eluting

An individualized, stepwise patient evaluation based on the degree of urgency of non-cardiac surgery, functional capacity, clinical presentation, and estimated cardiovascular stress related to surgery is recommended in order to assess the perioperative cardiovascular risk and optimize management. Myocardial ischaemia in the context of non-cardiac surgery may be related to acute coronary syndromes secondary to coronary plaque rupture or prolonged myocardial oxygen supply–demand imbalance. Randomized controlled trials have failed to show a benefit of routine preoperative prophylactic myocardial revascularization. Preoperative coronary angiography and, if appropriate, myocardial revascularization may be considered before high-risk surgery depending on symptom status and extent of ischaemia on non-invasive imaging. In patients requiring percutaneous coronary intervention, guidelines recommend new-generation drug-eluting stents over bare-metal stents, though randomized data are absent. While the minimal delay for a safe surgery following drug-eluting stent implantation remains to be defined, a time window of 5–6 weeks between percutaneous coronary intervention and surgery appears to be adequate in patients who cannot wait longer.

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