In many patients, comparable results can be achieved either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). The comparison of PCI versus CABG is frequently reported in randomised trials, national registries, multicentre collaborations and single-centre experiences. However, the patients included in these analyses are either highly selected (trials), or comprehensive (national registries and retrospective studies). Large registries differ from each other since indications for PCI or CABG may be different among geographic regions, hence the large PCI:CABG ratio variability that has been described. Some patients can only undergo bypass surgery because they have too complex coronary artery disease deemed unsuitable to be treated with PCI. In contrast, PCI can be the only treatment option if patients are deemed inoperable due to advanced age or severe co-morbidities. Separate analyses of these patients that are excluded from randomisation is needed to fully understand the strength, limitations and outcomes of PCI and CABG in selected patients. This review summarises the data of patients ineligible for randomisation and focuses specifically on the Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) PCI and CABG nested registries.
Percutaneous coronary intervention strategies and prognosis for graft lesions following coronary artery bypass grafting