The newest findings from the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) study finds a small benefit for CABG over PCI in relieving angina. The results of the SYNTAX quality of life substudy are published in the New England Journal of Medicine. Previous results from the SYNTAX trial, in which 1800 patients with 3-vessel or left main disease were randomized to either CABG or PCI, have generally favored CABG while leaving room for PCI in low risk patients.
In the quality of life substudy, both CABG and PCI were associated with a significant reduction in angina, but the larger reduction was found in CABG patients. At one year, 76.3% of CABG patients and 71.6% of PCI patients (p=0.05) were angina free. However, the SYNTAX investigators pointed out that the “symptomatic benefits of CABG were counterbalanced by the more rapid recovery and improved short-term health status achieved with PCI.”
In a Q&A on CardioExchange, SYNTAX lead investigator David Cohen says that for patients with daily or weekly angina it would be reasonable to consider CABG to be preferable to PCI. However, he notes, even when they are provided with the data from SYNTAX, “many patients may choose an initial PCI strategy to avoid the greater morbidity and more-prolonged recovery after CABG.”
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