Highlights from the 58th Annual Scientific Sessions of the American College of Cardiology, March 28 to 31, 2009, Orlando, Florida

Abstract

CORONARY ARTERY DISEASE AND CORONARY STENTS Quality of Life With Stents Versus Surgery in Treatment of Multivessel and Left Main Coronary Artery Disease The SYNTAX investigators explored the quality of life and cost-effectiveness of the strategy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for left main or multivessel coronary artery disease in this international randomized study of over 1600 patients. The group had previously published the 1-year outcomes from the study, which demonstrated similar rates of death and myocardial infarction at 12 months, with increased rates of repeat revascularization for the patients treated with PCI. Dr David Cohen reported that although angina relief was slightly better with CABG than drug-eluting stents (DES) at 6 and 12 months, the differences were very small, and the overall costs (including hospitalization and rehabilitation) were significantly higher at 1 year for the patients treated with CABG. The 1-year cost-effectiveness (based on US health care costs) significantly favored PCI for patients with low and moderate levels of angiographic complexity; CABG was economically attractive for patients with the most severe angiographic complexity (SYNTAX score > 32). Another cost-effectiveness analysis of the SYNTAX patients is planned when the 5-year follow-up data become available, which should allow some insight into the longterm cost-effectiveness of CABG versus PCI for patients with both multivessel coronary artery disease as well as left main coronary artery disease.