Article

Coronary Revascularisation in Patients Eligible Only for Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting - A Review with a Specific Focus on the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Nested

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Keywords

Heart team, coronary revascularisation, percutaneous coronary intervention, coronary artery bypass grafting, randomised trial, registry, Synergy between percutaneous coronary intervention with Taxus and cardiac surgery,

Disclosure:A Pieter Kappetein has received travel fees from Boston Scientific. The remaining authors have no conflicts of interest to declare.

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DOI:https://doi.org/10.15420/icr.2012.7.2.91

Correspondence Details:Stuart Head, Erasmus University Medical Center, Department of Cardio-thoracic Surgery, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E: s.head@erasmusmc.nl

Copyright Statement:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Abstract

In many patients, comparable results can be achieved either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). The comparison of PCI versus CABG is frequently reported in randomised trials, national registries, multicentre collaborations and single-centre experiences. However, the patients included in these analyses are either highly selected (trials), or comprehensive (national registries and retrospective studies). Large registries differ from each other since indications for PCI or CABG may be different among geographic regions, hence the large PCI:CABG ratio variability that has been described. Some patients can only undergo bypass surgery because they have too complex coronary artery disease deemed unsuitable to be treated with PCI. In contrast, PCI can be the only treatment option if patients are deemed inoperable due to advanced age or severe co-morbidities. Separate analyses of these patients that are excluded from randomisation is needed to fully understand the strength, limitations and outcomes of PCI and CABG in selected patients. This review summarises the data of patients ineligible for randomisation and focuses specifically on the Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) PCI and CABG nested registries.

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