Skip to main content
SpringerLink
Log in

Surgical Versus Percutaneous Revascularization in Patients with Multivessel Coronary Artery Disease

  • Clinical Trials and Their Interpretations (JR Kizer, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

New-generation stents have been continually developed in order to improve the safety and efficacy of percutaneous coronary intervention (PCI). Several randomized clinical trials have been conducted over the last two decades to compare the outcomes of PCI with coronary artery bypass grafting (CABG), which has been the time-tested treatment of multivessel coronary artery disease. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial is one of the most recent and largest randomized controlled trials comparing PCI using the paclitaxel-eluting first-generation stent with CABG and was uniquely formulated to represent “real world” daily practice. The final 5-year main results of this trial and its various prespecified subgroups have been published in the past year. These results will form the basis of the new guidelines that will be published in the near future. This review is a compilation of the results of the SYNTAX trial and comparisons with other contemporary trials, meta-analyses, and retrospective studies of large registries and how these results help cardiac surgeons and cardiologists in judicious decision-making for their patients with multivessel coronary artery disease requiring revascularization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98.

    CAS  PubMed  Google Scholar 

  2. The RITA-2 trial participants. Coronary angioplasty versus medical therapy for angina. Lancet. 1997;350:461–8.

    Google Scholar 

  3. Hueb W, Soares PR, Gersh BJ, et al. The medicine, angioplasty, or surgery study (MASS-II): a randomized, controlled clinical trial of three therapeutic strategies for multivessel coronary artery disease: one-year results. J Am Coll Cardiol. 2004;43:1743–51.

    PubMed  Google Scholar 

  4. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.

    CAS  PubMed  Google Scholar 

  5. The BARI 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–15.

    PubMed Central  Google Scholar 

  6. Bucher HC, Hengstler P, Schindler C, Guyatt GH. Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials. BMJ. 2000;321:73–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  7. Jeremias A, Kaul S, Rosengart TK, Gruberg L, Brown DL. The impact of revascularization on 4181 mortality in patients with nonacute coronary artery disease. Am J Med. 2009;122(2):152–61.

    PubMed  Google Scholar 

  8. Davies RF, Goldberg AD, Forman S, Pepine CJ, Knatterud GL, Geller N, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: outcomes of patients randomized to initial strategies of medical therapy versus revascularization. Circulation. 1997;95:2037–43.

    CAS  PubMed  Google Scholar 

  9. TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet. 2001;358:951–7.

    Google Scholar 

  10. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–91.

    PubMed  Google Scholar 

  11. Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994;344:563–70.

    CAS  PubMed  Google Scholar 

  12. Kolesov VI, Potashov LV. Surgery of coronary arteries [in Russian]. Eksp Khir Anesteziol. 1965;10:3–8.

    CAS  PubMed  Google Scholar 

  13. Cheng DC, Bainbridge D, Martin JE, Evidence-Based Perioperative Clinical Outcomes Research Group, et al. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology. 2005;102:188–203.

    PubMed  Google Scholar 

  14. Taggart DP, Lees B, Gray A, Art Investigators OB, et al. Protocol for the Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation. Trials. 2006;7:7.

    PubMed Central  PubMed  Google Scholar 

  15. Keogh BE, Kinsman R. Fifth national adult cardiac surgical database report 2003. Henley-on-Thames: Dendrite Clinical Systems; 2004.

    Google Scholar 

  16. O’Gara PT, Kushner FG, Ascheim DD, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362–425.

    PubMed  Google Scholar 

  17. Steg PG, James SK, Atar D, Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (ESC), et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–619.

    CAS  PubMed  Google Scholar 

  18. Serruys PW, Morice MC, Kappetein AP, SYNTAX Investigators, et al. Percutaneous coronary intervention versus coronary artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.

    CAS  PubMed  Google Scholar 

  19. Mohr FW, Morice MC, Kappetein PA, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three vessel disease and left main coronary disease: five-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381:629–38. This article reports the final 5-year results of the SYNTAX trial, which will play an important role in the shaping of the new guidelines for myocardial revascularization.

    PubMed  Google Scholar 

  20. Kappetein AP, Head SJ, Morice MC, SYNTAX Investigators, et al. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. Eur J Cardiothorac Surg. 2013;43:1006–13. This article reports the final 5-year results of the diabetic subgroup of the SYNTAX trial, and compares the long-term clinical outcomes between CABG and PCI and the impact of diabetes on the same.

    PubMed  Google Scholar 

  21. Head SJ, Davierwala PM, Serruys PW, et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J. 2014. This is the first article to report the results of the three-vessel disease subgroup of the SYNTAX trial. It includes detailed patient characteristics, early and 5-year outcomes.

  22. Grüntzig A. Transluminal dilatation of coronary-artery stenosis. Lancet. 1978;1:263.

    PubMed  Google Scholar 

  23. Cowley MJ, Vetrovec GW, DiSciascio G, et al. Coronary angioplasty of multiple vessels: short-term outcome and long-term results. Circulation. 1985;72:1314–20.

    CAS  PubMed  Google Scholar 

  24. Vandormael MG, Deligonul U, Kern MJ, et al. Multilesion coronary angioplasty: clinical and angiographic follow-up. J Am Coll Cardiol. 1987;10:246–52.

    CAS  PubMed  Google Scholar 

  25. O’Keefe Jr JH, Rutherford BD, McConahay DR, et al. Multivessel coronary angioplasty from 1980 to 1989: procedural results and long-term outcome. J Am Coll Cardiol. 1990;16:1097–102.

    PubMed  Google Scholar 

  26. Detre K, Holubkov R, Kelsey S, et al. Percutaneous transluminal coronary angioplasty in 1985–1986 and 1977–1981: the National Heart, Lung, and Blood Institute Registry. N Engl J Med. 1988;318:265–70.

    CAS  PubMed  Google Scholar 

  27. Sigwart U, Puel J, Mirkovitch V, et al. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med. 1987;316:701–6.

    CAS  PubMed  Google Scholar 

  28. Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. BENESTENT Study Group. N Engl J Med. 1994;331:489–95.

    CAS  PubMed  Google Scholar 

  29. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994;331:496–501.

    CAS  PubMed  Google Scholar 

  30. Versaci F, Gaspardone A, Tomai F, et al. A comparison of coronary-artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery. N Engl J Med. 1997;336:817–22.

    CAS  PubMed  Google Scholar 

  31. Serruys PW, van Hout B, Bonnier H, et al. Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II). Lancet. 1998;352:673–81.

    CAS  PubMed  Google Scholar 

  32. Kastrati A, Schomig A, Dirschinger J, et al. A randomized trial comparing stenting with balloon angioplasty in small vessels in patients with symptomatic coronary artery disease. ISAR-SMART Study Investigators. Intracoronary Stenting or Angioplasty for Restenosis Reduction in Small Arteries. Circulation. 2000;102:2593–8.

    CAS  PubMed  Google Scholar 

  33. Weaver WD, Reisman MA, Griffin JJ, et al. Optimum percutaneous transluminal coronary angioplasty compared with routine stent strategy trial (OPUS-1): a randomised trial. Lancet. 2000;355:2199–203.

    CAS  PubMed  Google Scholar 

  34. Brophy JM, Belisle P, Joseph L. Evidence for use of coronary stents. A hierarchical Bayesian meta-analysis. Ann Intern Med. 2003;138:777–86.

    PubMed  Google Scholar 

  35. Farb A, Sangiorgi G, Carter AJ, et al. Pathology of acute and chronic coronary stenting in humans. Circulation. 1999;99:44–52.

    CAS  PubMed  Google Scholar 

  36. Iqbal J, Gunn J, Serruys PW. Coronary stents: historical development, current status and future directions. Br Med Bull. 2013;106:193–211.

    CAS  PubMed  Google Scholar 

  37. Sousa JE, Serruys PW, Costa MA. New frontiers in cardiology: drug-eluting stents: part I. Circulation. 2003;107:2274–9.

    PubMed  Google Scholar 

  38. Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002;346:1773–80.

    CAS  PubMed  Google Scholar 

  39. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003;349:1315–23.

    CAS  PubMed  Google Scholar 

  40. Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350:221–31.

    CAS  PubMed  Google Scholar 

  41. Abizaid A. Sirolimus-eluting coronary stents: a review. Vasc Health Risk Manag. 2007;3:191–201.

    CAS  PubMed Central  PubMed  Google Scholar 

  42. Lasala JM, Stone GW, Dawkins KD, et al. An overview of the taxus express, paclitaxel-eluting stent clinical trial program. J Interv Cardiol. 2006;19:422–31.

    PubMed  Google Scholar 

  43. Babapulle MN, Joseph L, Bélisle P, et al. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet. 2004;364:583–91.

    CAS  PubMed  Google Scholar 

  44. Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, et al. Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet. 2009;373:911–8.

    PubMed Central  PubMed  Google Scholar 

  45. King 3rd SB, Lembo NJ, Weintraub WS, et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery. Emory Angioplasty versus Surgery Trial (EAST). N Engl J Med. 1994;331:1044–50.

    PubMed  Google Scholar 

  46. King SB, Kosinski AS, Guyton RA, et al. Eight-year mortality in the Emory Angioplasty Versus Surgery Trial (EAST). J Am Coll Cardiol. 2000;35:1116–21.

    PubMed  Google Scholar 

  47. Hampton JR, Henderson RA, Julian DG, et al. Coronary angioplasty versus coronary artery bypass surgery: the Randomised Intervention Treatment of Angina (RITA) trial. Lancet. 1993;341:573–80.

    Google Scholar 

  48. Henderson RA, Pocock SJ, Sharp SJ, et al. Long-term results of RITA-1 trial: clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting. Randomised Intervention Treatment of Angina. Lancet. 1998;352:1419–25.

    CAS  PubMed  Google Scholar 

  49. Rodriguez A, Mele E, Peyregne E, et al. Three-year follow-up of the Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease (ERACI). J Am Coll Cardiol. 1996;27:1178–84.

    CAS  PubMed  Google Scholar 

  50. Rickards AF, Ilsley C, Simon R, CABRI Trial Participants, et al. First-year results of CABRI (Coronary Angioplasty versus Bypass Revascularisation Investigation). Lancet. 1995;346:1179–84.

    Google Scholar 

  51. Hamm CW, Reimers J, Ischinger T, et al. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease. German Angioplasty Bypass Surgery Investigation (GABI). N Engl J Med. 1994;331:1037–43.

    CAS  PubMed  Google Scholar 

  52. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med. 1996;335:217–25.

    Google Scholar 

  53. BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol. 2007;49:1600–6.

    Google Scholar 

  54. Serruys PW, Ong ATL, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease. The final analysis of the Arterial Revascularization Therapies (ARTS) randomized trial. J Am Coll Cardiol. 2005;46:575–81.

    PubMed  Google Scholar 

  55. Rodriguez AE, Baldi J, Pereira CF, et al. Five-year follow-up of the Argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). J Am Coll Cardiol. 2005;46:582–8.

    PubMed  Google Scholar 

  56. Hueb W, Lopes NH, Gersh BJ, et al. Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II). A randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation. 2007;115:1082–9.

    PubMed  Google Scholar 

  57. Booth J, Clayton T, Pepper J, et al. Randomized, controlled trial of coronary artery bypass surgery versus percutaneous coronary intervention in patients with multivessel coronary artery disease. Six-year follow-up from the Stent or Surgery trial (SoS). Circulation. 2008;118:381–8.

    PubMed  Google Scholar 

  58. Hlatky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009;373:1190–7.

    PubMed  Google Scholar 

  59. Hoffman SN, TenBrook JA, Wolf MP, et al. A metaanalysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes. J Am Coll Cardiol. 2003;41:1293–304.

    PubMed  Google Scholar 

  60. Hannan EL, Racz MJ, Walford G, et al. Long-term outcomes of coronary-artery bypass grafting versus stent implantation. N Engl J Med. 2005;352:2174–83.

    CAS  PubMed  Google Scholar 

  61. Brener SJ, Lytle BW, Casserly IP, et al. Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features. Circulation. 2004;109:2290–5.

    PubMed  Google Scholar 

  62. Kappetein AP, Dawkins KD, Mohr FW, et al. Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease: insights from the SYNTAX run-in phase. Eur J Cardiothorac Surg. 2006;29:486–91.

    PubMed  Google Scholar 

  63. McFadden EP, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet. 2004;364:1519–21.

    CAS  PubMed  Google Scholar 

  64. Lagerqvist B, Carlsson J, Frobert O, et al. Stent thrombosis in Sweden: a report from the Swedish Coronary Angiography and Angioplasty Registry. Circ Cardiovasc Interv. 2009;2:401–8.

    PubMed  Google Scholar 

  65. Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al. Comparative effectiveness of revascularization strategies. N Engl J Med. 2012;366:1467–76.

    CAS  PubMed  Google Scholar 

  66. Ong AT, Serruys PW, Mohr FW, et al. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase. Am Heart J. 2006;151:1194–204.

    PubMed  Google Scholar 

  67. Kappetein AP, Feldman TE, Mack MJ, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J. 2011;32:2125–34.

    PubMed  Google Scholar 

  68. Wu C, Camacho FT, Zhao S, et al. Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents. Ann Thorac Surg. 2013;95:1297–305. This article represents the real world practice as it compares and analyzes the 5-year results of CABG and PCI in patients with multi-vessel coronary artery disease who were enrolled in a large registry.

    PubMed Central  PubMed  Google Scholar 

  69. Hannan EL, Wu C, Walford G, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358:331–41.

    CAS  PubMed  Google Scholar 

  70. Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) trial. Circulation. 2010;121:2645–53.

    CAS  PubMed  Google Scholar 

  71. Morice MC, Serruys PW, Kappetein AP, et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the SYNTAX trial. Circulation. 2014;129:2388–94. This article reports the results of the left main disease subgroup of the SYNTAX trial and compares the 5-year outcomes between CABG and PCI.

    PubMed  Google Scholar 

  72. Buszman PE, Kiesz SR, Bochenek A, et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol. 2008;51:538–45.

    PubMed  Google Scholar 

  73. Wu C, Hannan EL, Walford G, et al. Utilization and outcomes of unprotected left main coronary artery stenting and coronary artery bypass graft surgery. Ann Thorac Surg. 2008;86:1153–9.

    PubMed  Google Scholar 

  74. Seung KB, Park DW, Kim YH, et al. Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med. 2008;358:1781–92.

    CAS  PubMed  Google Scholar 

  75. Park SJ, Kim YH, Park DW, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med. 2011;364:1718–27.

    CAS  PubMed  Google Scholar 

  76. Bittl JA, He Y, Jacobs AK, et al. Bayesian methods affirm the use of percutaneous coronary intervention to improve survival in patients with unprotected left main coronary artery disease. Circulation. 2013;127:2177–85. This article is a meta-analysis of several randomized and observational studies comparing CABG with PCI and CABG with medical therapy in patients with unprotected left main disease.

    PubMed  Google Scholar 

  77. Jeong DS, Lee YT, Chung SR, et al. Revascularization in left main coronary artery disease: comparison of off-pump coronary artery bypass grafting vs percutaneous coronary intervention. Eur J Cardiothorac Surg. 2013;44:718–24. This article represents the real world practice as it compares and analyzes the 8-year results of off-pump CABG and PCI in patients with left main coronary artery disease who were enrolled in a large registry.

    PubMed  Google Scholar 

  78. Park DW, Kim YH, Yun SC, et al. Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN–MAIN (ASAN Medical Center–Left MAIN Revascularization) Registry. J Am Coll Cardiol. 2010;56:1366–75.

    PubMed  Google Scholar 

  79. Park DW, Kim YH, Yun SC, et al. Long-term safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 5-year results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) Registry. J Am Coll Cardiol. 2010;56:117–24.

    PubMed  Google Scholar 

  80. Fortuna D, Nicolini F, Guastaroba P, et al. Coronary artery bypass grafting vs percutaneous coronary intervention in a ‘real-world’ setting: a comparative effectiveness study based on propensity score-matched cohorts. Eur J Cardiothorac Surg. 2013;44:e16–24.

    PubMed  Google Scholar 

  81. De Oliveira Sá MPB, Ferraz PE, Escobar RR, et al. Five-year outcomes following PCI with DES versus CABG for unprotected LM coronary lesions: meta-analysis and meta-regression of 2914 patients. Rev Bras Cir Cardiovasc. 2013;28(1):83–92.

    Google Scholar 

  82. Kim YH, Park DW, Ahn JM, for the PRECOMBAT-2 Investigators, et al. Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis. The PRECOMBAT-2 (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) Study. J Am Coll Cardiol Intv. 2012;5:708–17.

    Google Scholar 

  83. Carson JL, Scholz PM, Chen AY, et al. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002;40:418–23.

    PubMed  Google Scholar 

  84. Stein B, Weintraub WS, Gebhart SSP, et al. Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty. Circulation. 1995;91:979–89.

    CAS  PubMed  Google Scholar 

  85. Weber FD, Schneider H, Wiemer M, et al. Sirolimus eluting stent (Cypher) in patients with diabetes mellitus: results from the German Cypher Stent Registry. Clin Res Cardiol. 2008;97:105–9.

    PubMed  Google Scholar 

  86. Banning AP, Westaby S, Morice M-C, et al. Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol. 2010;55:1067–75.

    CAS  PubMed  Google Scholar 

  87. Mack MJ, Banning AP, Serruys PW, et al. Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. Ann Thorac Surg. 2011;92:2140–6.

    PubMed  Google Scholar 

  88. Kappetein AP, Head SJ, Morice MC, et al. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. Eur J Cardiothorac Surg. 2013;43:1006–13.

    PubMed  Google Scholar 

  89. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367:2375–84.

    CAS  PubMed  Google Scholar 

  90. Verma S, Farkouh M, Yanagawa B, et al. Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2013;1:317–28. This article is a meta-analysis of several randomized comparing CABG with PCI in diabetic patients with multi-vessel disease.

    PubMed  Google Scholar 

  91. De Luca G, Schaffer A, Verdoia M, et al. Meta-analysis of 14 trials comparing bypass grafting vs drug-eluting stents in diabetic patients with multivessel coronary artery disease. Nutr Met Cardiovasc Dis. 2014;24:344–54. This article is a meta-analysis of several randomized comparing CABG with PCI in diabetic patients with multi-vessel disease.

    Google Scholar 

  92. Tarakji KG, Sabik 3rd JF, Bhudia SK, et al. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011;305:381–90.

    CAS  PubMed  Google Scholar 

  93. Bucerius J, Gummert JF, Borger MA, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003;75:472–8.

    PubMed  Google Scholar 

  94. Mack MJ, Head SJ, Holmes Jr DR, et al. Analysis of stroke occurring in the SYNTAX trial comparing coronary artery bypass surgery and percutaneous coronary intervention in the treatment of complex coronary artery disease. JACC Cardiovasc Interv. 2013;6. This article is an exclusive report on the occurrence of stroke after CABG and PCI in patients of the SYNTAX trial and discusses the possible causes of stroke.

  95. Doonan AL, Karha J, Carrigan TP, et al. Presence of carotid and peripheral arterial disease in patients with left main disease. Am J Cardiol. 2007;100:1087–9.

    PubMed  Google Scholar 

  96. Vigneswaran WT, Sapsford RN, Stanbridge RD. Disease of the left main coronary artery: early surgical results and their association with carotid artery stenosis. Br Heart J. 1993;70:342–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  97. Barbut D, Yao FF, Lo YW, et al. Determination of size of aortic emboli and embolic load during coronary artery bypass. Ann Thorac Surg. 1997;63:1262–7.

    CAS  PubMed  Google Scholar 

  98. Borger MA, Ivanov J, Weisel RD, et al. Stroke during coronary bypass surgery: principal role of macroemboli. Eur J Cardiothorac Surg. 2001;19:627–32.

    CAS  PubMed  Google Scholar 

  99. Calafiore AM, Di Mauro M, Teodori G, et al. Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization. Ann Thorac Surg. 2002;73:1387–93.

    PubMed  Google Scholar 

  100. Kotoh K, Fukahara K, Doi T, et al. Predictors of early postoperative cerebral infarction after isolated offpump coronary artery bypass grafting. Ann Thorac Surg. 2007;83:1679–83.

    PubMed  Google Scholar 

  101. Kapetanakis EI, Stamou SC, Dullum MK, et al. The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study. Ann Thorac Surg. 2004;78:1564–71.

    PubMed  Google Scholar 

  102. Misfeld M, Brereton RJL, Sweetman EA, Doig GS. Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation: metaanalysis of 11,398 cases from 8 studies. J Thorac Cardiovasc Surg. 2011;142:e11–7.

    PubMed  Google Scholar 

  103. Davierwala PM, Leontyev S, Misfeld M, et al. No-touch aorta off-pump coronary bypass operation: arteriovenous composite grafts may be used as a last resort. Ann Thorac Surg. 2013;95:846–53.

    PubMed  Google Scholar 

  104. Emmert MY, Seifert B, Wilhelm M, et al. Aortic no-touch technique makes the difference in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2011;142:1499–506.

    PubMed  Google Scholar 

  105. Serruys PW, Unger F, Sousa JE, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med. 2001;344:1117–24.

    CAS  PubMed  Google Scholar 

  106. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet. 2007;370:937–48.

    CAS  PubMed  Google Scholar 

  107. Lagerqvist B, James SK, Stenestrand U, et al. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med. 2007;356:1009–19.

    CAS  PubMed  Google Scholar 

  108. Stone GW, Moses JW, Ellis SG, et al. Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Engl J Med. 2007;356:998–1008.

    CAS  PubMed  Google Scholar 

  109. Mauri L, Hsieh WH, Massaro JM, et al. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med. 2007;356:1020–9.

    CAS  PubMed  Google Scholar 

  110. Kim FY, Marhefka G, Ruggiero N, et al. Saphenous vein graft disease: review of pathophysiology, prevention, and treatment. Cardiol Rev. 2013;21(2):101–9.

    PubMed  Google Scholar 

  111. Desai ND, Naylor CD, Kiss A, et al. Impact of patient and target vessel characteristics on arterial and venous bypass graft patency: insight from a randomized trial. Circulation. 2007;115:684–91.

    PubMed  Google Scholar 

  112. Raber L, Magro M, Stefanini GG, et al. Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents: a prospective cohort study. Circulation. 2012;125:1110–21.

    PubMed  Google Scholar 

  113. Stefanini GG, Byrne RA, Serruys PW, et al. Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials. Eur Heart J. 2012;33:1214–22.

    CAS  PubMed  Google Scholar 

  114. Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012;125:2873–91.

    CAS  PubMed  Google Scholar 

  115. Buxton BF, Komeda M, Fuller JA, et al. Bilateral internal thoracic artery grafting may improve outcome of coronary artery surgery. Risk-adjusted survival. Circulation. 1998;98:II1–6.

    CAS  PubMed  Google Scholar 

  116. Lytle BW, Blackstone EH, Sabik JF, et al. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg. 2004;78:2005–12. discussion 2012-4.

    PubMed  Google Scholar 

  117. Taggart DP, Altman DG, Gray AM, et al. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J. 2010;31:2470–81.

    PubMed  Google Scholar 

  118. Rankin JS, Tuttle RH, Wechsler AS, et al. Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up. Ann Thorac Surg. 2007;83:1008–14.

    PubMed  Google Scholar 

  119. Parsa CJ, Shaw LK, Rankin JS, Daneshmand MA, et al. Twenty-five-year outcomes after multiple internal thoracic artery bypass. J Thorac Cardiovasc Surg. 2013;145(4):970–5. This article compares the extended follow-up in patients receiving none, one or two internal thoracic arteries during CABG.

    PubMed  Google Scholar 

  120. Kurlansky PA, Traad EA, Dorman MJ, et al. Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups. Ann Thorac Surg. 2010;90:101–8.

    PubMed  Google Scholar 

  121. Head SJ, Holmes DR, Mack MJ, et al. Risk profile and 3-year outcomes from the SYNTAX percutaneous coronary intervention and coronary artery bypass grafting nested registries. J Am Coll Cardiol Intv. 2012;5:618–25.

    Google Scholar 

  122. Davierwala P, Mohr FW. Five years after the SYNTAX trial: what have we learnt? Eur J Cardiothorac Surg. 2013;44:1–3.

    PubMed  Google Scholar 

  123. Head SJ, Kaul S, Mack MJ, et al. The rationale for heart team decision-making for patients with stable complex coronary artery disease. Eur Heart J. 2013;34:2510–8.

    PubMed  Google Scholar 

  124. Holmes Jr DR, Rich JB, Zoghbi WA, et al. The heart team of cardiovascular care. J Am Coll Cardiol. 2013;61:903–7.

    PubMed  Google Scholar 

  125. Wijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2010;31:2501–55.

    PubMed  Google Scholar 

  126. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:e652–735.

    PubMed  Google Scholar 

  127. Smits PC, Kedhi E, Royaards KJ, et al. 2-Year follow-up of a randomized controlled trial of everolimus- and paclitaxel-eluting stents for coronary revascularization in daily practice COMPARE (Comparison of the everolimus eluting XIENCE-V stent with the paclitaxel eluting TAXUS LIBERTE′ stent in all-comers: a randomized open label trial). J Am Coll Cardiol. 2011;58:11–8.

    PubMed  Google Scholar 

  128. Maeng M, Tilsted HH, Jensen LO, et al. Differential clinical outcomes after 1 year versus 5 years in a randomised comparison of zotarolimus-eluting and sirolimus-eluting coronary stents (the SORT OUT III study): a multicentre, open-label, randomised superiority trial. Lancet. 2014;383:2047–56.

    CAS  PubMed  Google Scholar 

  129. Yi G, Joo HC, Youn YN, et al. Stent versus off-pump coronary bypass grafting in the second-generation drug-eluting stent era. Ann Thorac Surg. 2013;96:535–42. This article is one of the very first reports on the outcomes of PCI with new generation stents versus CABG.

    PubMed  Google Scholar 

  130. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1:219–27.

    PubMed  Google Scholar 

  131. Capodanno D, Miano M, Cincotta G, et al. EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention. Am Heart J. 2010;159:103–9.

    PubMed  Google Scholar 

  132. Serruys PW, Farooq V, Vranckx P, et al. A global risk approach to identify patients with left main or 3-vessel disease who could safely and efficaciously be treated with percutaneous coronary intervention. The SYNTAX trial at 3 years. J Am Coll Cardiol Intv. 2012;5:606–17.

    Google Scholar 

  133. Capodanno D, Caggegi A, Miano M, et al. 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 Cardiovasc Interv. 2011;4:287–97.

    PubMed  Google Scholar 

  134. Farooq V, van Klaveren D, Steyerberg EW, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet. 2013;381:639–50. This article describes the SYNTAX score II, its validation and development.

    PubMed  Google Scholar 

  135. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER study. J Am Coll Cardiol. 2007;49:2105–11.

    PubMed  Google Scholar 

  136. Tonino PA, De Bruyne B, Pijls NH, FAME Study Investigators, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.

    CAS  PubMed  Google Scholar 

  137. Toth G, De Bruyne B, Casselman F, et al. Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery. Circulation. 2013;128:1405–11.

    PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Piroze Davierwala and Friedrich-Wilhelm Mohr declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, Heart Center, University of Leipzig, Struempellstraße 39, 04289, Leipzig, Germany

    Piroze M. Davierwala & Freidrich W. Mohr

Authors
  1. Piroze M. Davierwala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Freidrich W. Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Freidrich W. Mohr.

Additional information

This article is part of the Topical Collection on Clinical Trials and Their Interpretations

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Davierwala, P.M., Mohr, F.W. Surgical Versus Percutaneous Revascularization in Patients with Multivessel Coronary Artery Disease. Curr Atheroscler Rep 16, 461 (2014). https://doi.org/10.1007/s11883-014-0461-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-014-0461-x

Keywords

Search

Navigation