3 Jahre nach SYNTAX -Stent oder Skalpell?

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• 作者：Lenard Conradi (1)
  Prof. Dr. Dr. Hermann Reichenspurner (1)
  
• 关键词：Bypassoperation ; PCI ; Koronare Herzerkrankung ; Hauptstammbeteiligung ; Heart ; Team ; Coronary surgery ; PCI ; Multi ; vessel coronary artery disease ; Left main disease ; Heart Team
• 刊名：Clinical Research in Cardiology Supplements
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：6
• 期：1-supp
• 页码：43-48
• 全文大小：1026KB
• 参考文献：1. Grüntzig A (1978) Transluminal dilatation of coronary-artery stenosis. Lancet 1:263 CrossRef
  2. Zahn R, Hamm CW, Schneider S, Zeymer U, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Sabin G, Nienaber CA, Pfannebecker T, Senges J; German Cypher Stent Registry (2007) The sirolimus-eluting coronary stent in daily routine practice in Germany: trends in indications over the years. Results from the prospective multi-center german cipher stent registry. Clin Res Cardiol 96:548-56 CrossRef
  3. Kappetein AP, Dawkins KD, Mohr FW, Morice MC, Mack MJ, Russell ME, Pomar J, Serruys PW (2006) Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease: insights from the SYNTAX run-in phase. Eur J Cardiothorac Surg 29:486-91 CrossRef
  4. Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 20:2501-555
  5. Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA, American College of Cardiology Foundation Appropriateness Criteria Task Force et al (2009) ACCF/SCAI/STS/AATS/AHA/ASNC 2009 appropriateness criteria for coronary revascularization. J Am Coll Cardiol 53:530-53 CrossRef
  6. Daemen J, Boersma E, Flather E, Booth J, Stables R, Rodriguez A, Rodriguez-Granillo G, Hueb WA, Lemos PA, Serruys PW (2008) Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II and SoS trials. Circulation 118:1146-154 CrossRef
  7. Hoffmann SN, TenBrook JA, Wolf MP, Pauker SG, Salem DN, Wong JB (2003) A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes. J Am Coll Cardiol 41:1293-304 CrossRef
  8. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE; SIRIUS Investigators (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315-323 CrossRef
  9. Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH (2008) Drug-eluting stents vs. coronary artery bypass grafting in multivessel coronary disease. N Engl J Med 358:331-41 CrossRef
  10. Morrison DA, Sethi G, Sacks J, Henderson W, Grover F, Sedlis S, Esposito R, Ramanathan K, Weiman D, Saucedo J et al (2001) Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. Investigators of the Department of Veterans Affairs Cooperative Study #385, the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME). J Am Coll Cardiol 38:143-49 CrossRef
  11. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, St?hle E, Feldman TE, van den Brand M, Bass EJ et al (2009) Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360:961-72 CrossRef
  12. Ong AT, Serruys PW, Mohr FW, Morice MC, Kappetein AP, Holmes DR Jr, Mack MJ, van den Brand M, Morel MA, van Es GA et al (2006) The SYNergy between percutaneous intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase. Am Heart J 151:1194-204 CrossRef
  13. Kappetein AP (2010) Optimal revascularization strategy in patients with three-vessel disease and/or left main disease. The 3-years outcomes of the SYNTAX trial. EACTS, Geneva
  14. Mohr FW (2010) SYNTAX 3VD: three-year outcomes from a prospective randomized trial of paclitaxel-eluting stents compared to bypass graft surgery in patients with triple vessel coronary artery disease. TCT, Washington
  15. Serruys PW (2010) SYNTAX left main: three-year outcomes from a prospective randomized trial of paclitaxel-eluting stents compared to bypass graft surgery in patients with left main coronary artery disease. TCT, Washington
  
• 作者单位：Lenard Conradi (1)
  Prof. Dr. Dr. Hermann Reichenspurner (1)
  
  1. Klinik und Poliklinik für Herz- und Gef??chirurgie, Universit?res Herzzentrum Hamburg, Martinistr. 52, 20246, Hamburg, Deutschland
  

文摘

Coronary artery bypass grafting (CABG) is the standard of care for patients with three-vessel or left main coronary artery disease. However, clinical practice has proven to differ substantially with even the most complex coronary lesions being targeted by percutaneous coronary intervention (PCI) today. An abundancy of both large registries and randomized clinical trials has demonstrated superiority of surgery over PCI in advanced coronary artery disease. Recently, these results have been confirmed by the landmark SYNTAX trial where CABG was found to be superior to PCI for three-vessel and/or left main coronary artery disease regarding repeat revascularization, rate of myocardial infarction, and cardiac mortality at the latest follow-up of 3?years. On the other hand, PCI proved to be a viable alternative for less complex forms of left main disease. In conclusion, patients with three-vessel and/or left main coronary artery disease should be discussed in an interdisciplinary heart team consisting of cardiologists and cardiac surgeons within a heart center. Final decision making should be a formal process as recommended in the recently updated guidelines on myocardial revascularization by the European Society of Cardiology.