2011 Top Game Changers in Cardiology

Henry R. Black, MD; David J. Maron, MD; Ileana L. Pina, MD; Carol Peckham


November 23, 2011

In This Article

Editor's Note:

We polled our Medscape advisors to find out which studies or events in 2011 had a major impact on the field of cardiology. The following are extracts from Medscape news items that presented them.

10. Death Rates Diverge but no Change in Advice: SYNTAX

SYNTAX was an 1800-patient trial conducted in Europe and the United States that randomized patients with left main coronary disease and/or 3-vessel disease to either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) using the Taxus® drug-eluting stent (DES; Boston Scientific Corp., Quincy, Massachusetts).[1]At 3 years, rates of the primary endpoint, major adverse cardiac and cerebrovascular event (MACCE), remained statistically lower in the CABG-treated patients, driven by the lower rates of repeat revascularization procedures -- just under 11% in the CABG-treated patients vs nearly 20% in the PCI/DES group. For the hard composite endpoint of all-cause death, stroke, and MI out to 3 years, there were no differences between groups.

On October 25th, 2011 at the European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting, 4-year data from the SYNTAX trial showed, for the first time, a divergence in death rates between the patients who were treated with bypass surgery and those who underwent PCI with a Taxus stent. All-cause mortality and cardiac death were both significantly higher in the PCI group compared with the surgery group, as was MI, and the excess rate of strokes initially observed in the CABG group has now leveled out.

In a discussion about who had "won" the SYNTAX trial, Dr Michael Mack (Medical City Dallas Hospital, Texas), a surgeon and chair of the session, said, "The surgeon would say the longer you go in follow-up, the better surgery looks. We knew this was going to look good 4 to 5 years out. But as an interventionalist, you might say, "We don't use Taxus stents any more, we use the everolimus-eluting Xience® [Abbott Laboratories], and the results wouldn't be the same."

Read the full news story on this trial here.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.