Analysis of Stroke Occurring in the SYNTAX Trial Comparing Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in the Treatment of Complex Coronary Artery Disease

作者：Mack Michael J^*; Head Stuart J; Holmes David R Jr; Staehle Elisabeth; Feldman Ted E; Colombo Antonio; Morice Marie Claude; Unger Felix; Erglis Andrejs; Stoler Robert; Dawkins Keith D; Serruys Patrick W; Mohr Friedrich W; Kappetein A Pieter

来源：JACC: Cardiovascular Interventions , 2013, 6(4): 344-354.

DOI：10.1016/j.jcin.2012.11.010

• coronary artery bypass graft
• drug-eluting stent(s)
• percutaneous coronary intervention
• stroke
• SYNTAX
• Taxus

Objectives This study sought to analyze stroke rates in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial%26apos;s randomized and registry cohorts of patients being treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for treatment of complex coronary artery disease. %26lt;br%26gt;Background The SYNTAX trial compared PCI to CABG in patients with de novo 3-vessel and/or left main coronary disease. %26lt;br%26gt;Methods The SYNTAX randomized trial was conducted at 85 U. S. and European sites (n = 1,800). All strokes (up to 4 years) were independently adjudicated by a clinical events committee that included a neurologist. An additional 1,077 (of which 644 were followed for 5 years) and 198 patients were included in the CABG and PCI registries, respectively. %26lt;br%26gt;Results In the randomized cohort, 31 CABG and 19 PCI patients experienced 33 and 20 strokes post-randomization at 4-year follow-up, respectively (p = 0.062). Three strokes occurred pre-procedurally but following randomization in CABG-treated patients. After CABG, a large proportion of strokes occurred acutely (0 to 30 days: 9 of 33), whereas in the PCI arm, most strokes occurred %26gt;30 days after the procedure (18 of 20). Stroke resulted in death in 3 patients in both the PCI and CABG groups. Of the patients who developed stroke, 68% (21 of 31) in the CABG group had residual deficits at discharge; in the PCI group, 47% (9 of 19) had residual deficits. In a multivariate analysis, treatment with CABG was not significantly associated with increased stroke rates (odds ratio: 1.67, 95% confidence interval: 0.93 to 3.01, p = 0.089). The incidence and outcomes of stroke were similar in the randomized trial and registries. %26lt;br%26gt;Conclusions There is a higher risk of periprocedural stroke in patients undergoing CABG versus PCI; however, the risk converges over the first 4 years of follow-up. (SYNTAX Study: TAXUS Drug-

• 出版日期2013-4
• 单位西北大学