Heart Care Info - Heart Disease Prevention & Treatment

... De Novo Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the ...

BF Uretsky - Circulation, 2011 - Am Heart Assoc I read with great interest the report by Morice et al on the left main (LM) subgroup of the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial. 1 This landmark trial was used as the major piece of evidence to upgrade ...

Letter by Uretsky Regarding Article, “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”

I read with great interest the report by Morice et al on the left main (LM) subgroup of the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial.1 This landmark trial was used as the major piece of evidence to upgrade LM stenting to a class IIB indication in the 2009 American College of Cardiology/American Heart Association percutaneous coronary intervention update.2 According to the SYNTAX definition, significant LM stenosis required either a lesion of >50% in the LM or the ostia of both left anterior and circumflex arteries. It is therefore quite interesting that, based on core laboratory analysis, >one third of SYNTAX LM patients (35.2%) did not, by study definition, meet the criteria for significant LM disease.

It would be of value to know whether the investigators compared the outcomes, both for coronary artery bypass graft and percutaneous coronary intervention, of patients who did not meet the SYNTAX definition of LM disease versus those who did. It would also be interesting to compare percutaneous coronary intervention versus coronary artery bypass graft in the two thirds of patients meeting core laboratory criteria for significant LM disease. These results, albeit limited by the post hoc nature of the analysis, may have important bearing on the need for quantitative coronary angiography or other techniques, such as fractional flow reserve or intravascular ultrasound, in refining the anatomic characteristics for decision making in this group of patients. Morice et al are to be complimented on their ...

Correspondence: Response to Letter Regarding Article, “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”