o:3266 Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease en BACKGROUND: The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease, and reported results up to 5 years. We now report 10-year all-cause death results. METHODS: The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to the PCI group or CABG group. Patients with a history of PCI or CABG, acute myocardial infarction, or an indication for concomitant cardiac surgery were excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause death, which was assessed according to the intention-to-treat principle. Prespecified subgroup analyses were performed according to the presence or absence of left main coronary artery disease and diabetes, and according to coronary complexity defined by core laboratory SYNTAX score tertiles. This study is registered with ClinicalTrials.gov, NCT03417050. FINDINGS: From March, 2005, to April, 2007, 1800 patients were randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status information at 10 years was complete for 841 (93%) patients in the PCI group and 848 (95%) patients in the CABG group. At 10 years, 244 (27%) patients had died after PCI and 211 (24%) after CABG (hazard ratio 1·17 [95% CI 0·97–1·41], p=0·092). Among patients with three-vessel disease, 151 (28%) of 546 had died after PCI versus 113 (21%) of 549 after CABG (hazard ratio 1·41 [95% CI 1·10–1·80]), and among patients with left main coronary artery disease, 93 (26%) of 357 had died after PCI versus 98 (28%) of 348 after CABG (0·90 [0·68–1·20], pinteraction=0·019). There was no treatment-by-subgroup interaction with diabetes (pinteraction=0·66) and no linear trend across SYNTAX score tertiles (ptrend=0·30). INTERPRETATION: At 10 years, no significant difference existed in all-cause death between PCI using first-generation paclitaxel-eluting stents and CABG. However, CABG provided a significant survival benefit in patients with three-vessel disease, but not in patients with left main coronary artery disease. Appendix: https://unilib.phaidrabg.rs/o:3267 Key words: percutaneous coronary intervention, coronary artery bypass grafting 91552100 128663305 1552101 0140-6736 1552099 10.1016/S0140-6736(19)31997-X 2023-11-17T19:52:36.931Z 44 yes 46 Daniel F.M. Thuijs 106246921 2019 46 A. Pieter Kappetein 46 Patrick W. Serruys 46 Friedrich-Wilhelm Mohr 46 Marie-Claude Morice 46 Michael J. Mack 46 David R. Holmes Jr. 46 Nick Curzen 46 Piroze Davierwala 46 Thilo Noack 46 Milan Milojević 106163721 0000-0003-0984-9011 2019 46 Keith D. Dawkins 46 Bruno R. Da Costa 46 Peter Juni 46 Stuart J. Head 46 SYNTAX Extended Survival Investigators institution application/pdf 794395 https://unilib.phaidrabg.rs/o:3266 no yes 1 70 616.1-089 92000001 71A11 Lancet 394 10206 1325 1334 2019