Outcome of percutaneous coronary intervention versus coronary artery bypass grafting for patients with intermediate SYNTAX II score.

BACKGROUND: Patients with intermediate SYNTAX II score have been representing a confusion in our daily practice for interventional cardiologists whether to treat them by percutaneous coronary intervention (PCI) using second generation drug eluting stents or by coronary artery bypass grafting (CABG).

METHODS: We enrolled 214 consecutive patients with intermediate SYNTAX II score to undergo revascularization (109 patients underwent PCI and 105 patients underwent CABG) after Heart Team discussion. We compared both procedures with respect to the primary composite end point of major adverse cardiac or cerebrovascular events (all-cause mortality, myocardial infarction, target vessel revascularization or stroke) at 40 months post procedure.

RESULTS: At 40 months post revascularization procedure, the primary end-point occurred in 22 patients and 15 patients in the PCI and CABG groups, respectively (hazard ratio, 1.65; 95% confidence interval, 0.87 to 3.14; P = 0.13). No significant differences were detected between both groups regarding the composite incidence of all-cause mortality, myocardial infarction, target vessel revascularization and stroke. CABG significantly provided better quality of life than PCI for patients with intermediate SYNTAX II score.

CONCLUSION: In patients with intermediate SYNTAX II score, there was no statistically significant difference between PCI using second generation drug eluting stents and CABG with respect to the incidence of MACCE at 40 months post revascularization procedure.