The SYNTAX trial is the landmark RCT for cardiothoracic surgeons. CABG versus PCI. In this international trial 1800 patients with three-vessel or left main coronary artery disease were randomly assigned to either revascularisation with CABG or PCI. Those undergoing PCI were found to be more likely to reach the primary end point of death from any cause, stroke, AMI, or repeat revascularisation.

Fundamentally allowing cardiothoracic surgeons to continue to crack chests and perform bypass surgery!

Interestingly the 10 year follow up has recently been published in the LANCET suggesting that CABG provides a significant survival benefit in patients with three-vessels disease, but not with left main coronary artery disease.

Check out the full articles at: Serruys P, Morice M, Kappetein P, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360:961-972. DOI: 10.1056/NEJMoa0804626

Thuijs D, Kappetein A, Serruys P, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. LANCET. 2019; 392: 818