For three-vessel and/or left main coronary artery disease, percutaneous coronary intervention (PCI) with paclitaxel-eluting stents is equivalent to coronary artery bypass grafting (CABG) for overall mortality and myocardial infarction rate at 12 months.  PCI patients had increased risk for repeat revascularization procedures, but a reduced risk of subsequent stroke when compared to CABG patients (level 2 [mid-level] evidence).  

Traditionally, CABG is preferred with multi-vessel coronary artery disease, and it has been shown to reduce mortality compared to PCI with stenting in the Stent or Surgery (SoS) trial (level 1 [likely reliable] evidence). However, the SoS trial did not use drug eluting stents. Recently, the SYNTAX trial has compared CABG to PCI with paclitaxel-eluting stent in 1,800 patients (mean age 65 years) with previously untreated 3-vessel and/or left main coronary artery disease. At 12 months, there were no significant differences in overall mortality or myocardial infarction rates. PCI with paclitaxel-eluting stent patients had lower rates of stroke (0.6% vs. 2.2%, p = 0.003, NNT 62) but higher rates of repeat revascularization (13.5% vs. 5.9%, p < 0.001, NNH 14).  There were several limitations to the trial including differential withdrawal rates (not accounted for in intention-to-treat analysis) and differences in medication management between the 2 groups (N Engl J Med 2009 Mar 5;360(10):961).

For more information, see the Percutaneous coronary intervention vs. coronary artery bypass grafting topic in DynaMed.