Nuffield Department of Surgery, Oxford University, John Radcliffe Hospital, Oxford, UK.
Curr Opin Cardiol. 2011 Nov;26(6):502-7. doi: 10.1097/HCO.0b013e32834ba1e6.
The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) trial is the most important trial of surgery and stents in patients with severe coronary artery disease (CAD) and reflects real clinical practice. This review describes its key findings at 3 years with particular reference to what is already known on this topic.
Taking together the SYNTAX randomized trial and its registry component, almost 79% of patients with three-vessel CAD and almost two-thirds of patients with left main stem (LMS) disease have a survival benefit and marked reduction in the need for repeat revascularization with coronary artery bypass grafting (CABG) in comparison to stents, implying that CABG is still the treatment of choice for most of these patients. This conclusion, at odds with results of previous trials of stenting and surgery but consistent with findings of large propensity-matched registries, can be explained by the fact that SYNTAX enrolled 'real life' patients rather than the highly select patients in previous trials. SYNTAX also shows that for patients with less severe CAD there is no difference in survival between CABG and stents but a lower incidence of repeat revascularization with CABG.
The results of the SYNTAX trial confirm that at 3 years CABG remains the treatment of choice for most patients with three-vessel and LMS disease and especially in those with the most severe disease. SYNTAX will have a profound effect on practice recommendations for the foreseeable future and already has had a major effect on the new European Society for Cardiology/European Association for Cardiothoracic Surgery guidelines for myocardial revascularization.
经皮冠状动脉介入治疗与紫杉醇和心脏手术（SYNTAX）试验是最重要的手术和支架治疗严重冠状动脉疾病（CAD）患者的试验，反映了真实的临床实践。这篇综述描述了其 3 年的关键发现，并特别提到了该主题的已有知识。
综合 SYNTAX 随机试验及其注册部分，近 79%的三血管 CAD 患者和约三分之二的左主干（LMS）疾病患者与支架相比，具有生存获益和明显减少再次血运重建的需求冠状动脉旁路移植术（CABG），这意味着 CABG 仍然是这些患者的治疗选择。这一结论与以前支架和手术试验的结果不一致，但与大型倾向匹配注册研究的结果一致，可以用以下事实来解释：SYNTAX 招募了“真实生活”的患者，而不是以前试验中高度选择的患者。SYNTAX 还表明，对于 CAD 程度较轻的患者，CABG 和支架治疗在生存率方面没有差异，但 CABG 的再次血运重建发生率较低。
SYNTAX 试验的结果证实，3 年后 CABG 仍然是大多数三血管和 LMS 疾病患者的首选治疗方法，尤其是那些疾病最严重的患者。SYNTAX 将对可预见的未来的实践建议产生深远影响，并且已经对新的欧洲心脏病学会/欧洲心胸外科学会心肌血运重建指南产生了重大影响。
