New England Journal of Medicine Publishes Results from Boston Scientific's Landmark SYNTAX(TM) Trial
Posted on: Wednesday, 18 February 2009, 16:01 CST
Data show comparable safety for complex patients treated with TAXUS(R) Express2(TM) Stents and bypass surgery
The SYNTAX trial is the first randomized, controlled clinical trial to compare these two treatments in patients with left main disease and three-vessel disease. These patient groups are typically treated with CABG and represent a population with far more complex anatomy and advanced disease than those studied in prior drug-eluting stent (DES) clinical trials.
"SYNTAX has provided the medical community with critical information on the management of patients with advanced and complex CAD," said
The SYNTAX trial enrolled 1,800 patients in its randomized arm, using an innovative consecutive enrollment methodology. All patients were assessed by a multidisciplinary team including an interventional cardiologist and a cardiac surgeon. If both the cardiologist and surgeon felt they could offer equivalent complete revascularization, patients were randomized 1:1 into one of the two treatment strategies (PCI or CABG). If either the cardiologist or surgeon felt that one revascularization technique was the preferred treatment, then patients were not randomized, but were entered into the corresponding registry. Accordingly, patients in the PCI registry had been rejected for cardiac surgery, and patients in the CABG registry had been rejected for PCI.
The patients recruited in the SYNTAX trial are a unique study group in the PCI field, given their exceptionally complex anatomy and advanced disease. The average PCI-treated patient enrolled in SYNTAX received 4.6 stents. By contrast, the average number of stents implanted in a PCI patient in everyday practice is 1.5. Further evidence of the complex nature of PCI-treated patients enrolled in SYNTAX include 33 percent of patients with >100 millimeters stented length, 72 percent with bifurcations, 22 percent with total occlusions and 39 percent with left main disease.
The final one-year results published today showed similar safety for the two randomized groups, with a combined rate of all-cause death, stroke and myocardial infarction (MI) of 7.6 percent for PCI and 7.7 percent for CABG (p=0.98). The rate of stroke itself was significantly lower for PCI (0.6 percent for PCI as compared to 2.2 percent for CABG, p=0.003). Overall 12-month MACCE (all-cause death, stroke, MI and repeat revascularization), however, was significantly higher for PCI (17.8 percent versus 12.4 percent, p=0.002), due to more repeat revascularization in the PCI arm (13.5 percent versus 5.9 percent, p=0.001). Most repeat revascularizations in the PCI arm, however, were performed by additional PCI, with only 2.8 percent of PCI patients ultimately requiring CABG.
"Boston Scientific is proud to sponsor the SYNTAX trial, and we are pleased that our robust DES clinical trial program is providing physicians with additional data to determine optimal treatment strategies for patients with challenging coronary artery disease," said
The SYNTAX trial broke new ground by scientifically defining a new measure for anatomical complexity -- the SYNTAX(TM) Score(TM) -- which characterizes vasculature based on lesion number, complexity and location. In fact, PCI patients in the lower one-third of raw SYNTAX Score results had similar 12-month combined MACCE rates to CABG patients (13.6 percent for PCI and 14.7 percent for CABG, p=0.71).
The TAXUS Express2 Paclitaxel-Eluting Coronary Stent System used in the SYNTAX trial has now been replaced by the Company's second-generation TAXUS(R) Liberte(R) Paclitaxel-Eluting Coronary Stent System, which has been approved for use in
Boston Scientific is a worldwide developer, manufacturer and marketer of medical devices whose products are used in a broad range of interventional medical specialties. For more information, please visit: www.bostonscientific.com.
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CONTACTS: Paul Donovan 508-650-8541 (office) 508-667-5165 (mobile) Media Relations Boston Scientific Corporation Larry Neumann 508-650-8696 (office) Investor Relations Boston Scientific CorporationSOURCE Boston Scientific Corporation
Source: PR Newswire
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