{"id":"8673375fc10c","type":"article","url":"https://hartvaat.nl/2022/10/28/pci-versus-cabg-bij-drievatslijden-met-proximale-lad-betrokkenheid/","title":"PCI versus CABG bij drievatslijden met proximale LAD-betrokkenheid","title_en":"Mortality after multivessel revascularisation involving the proximal left anterior descending artery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-320934","source_url":"https://doi.org/10.1136/heartjnl-2022-320934","authors":["Masafumi Ono","Hironori Hara","Chao Gao","Hideyuki Kawashima","Rutao Wang","Neil O'Leary","Joanna J Wykrzykowska","Jan J Piek","Michael J Mack","David Holmes","Marie-Claude Morice","Stuart Head","Arie Pieter Kappetein","Thilo Noack","Piroze M Davierwala","Friedrich W Mohr","Scot Garg","Yoshinobu Onuma","Patrick W Serruys"],"significance":7,"published":"2022-10-28","source_date":"2022-10-28","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"This study confirmed that CABG provides superior long-term survival compared with PCI in patients with three-vessel disease involving the proximal LAD, reinforcing the importance of surgical revascularization when this critical territory is involved.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T13:29:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek langetermijnmortaliteit na PCI versus CABG bij drievatslijden met betrokkenheid van de proximale LAD. CABG was geassocieerd met betere overleving, consistent met huidige richtlijnen die CABG aanbevelen bij deze anatomie.","abstract_original":"OBJECTIVE: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD). METHODS: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed. RESULTS: Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality. CONCLUSIONS: Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG. TRIAL REGISTRATION NUMBER: SYNTAXES: NCT03417050; SYNTAX: NCT00114972."}