SYNTAX, CARDia and FAME in practice

Should data from SYNTAX, CARDIA and FAME change our practice? How can we apply lessons from these key studies to individual patients and teams? These were the key questions that ten experts discussed, chaired by Marie-Claude Morice and Jose- Luis Pomar in Wednesday morning’s ′Glimpse Into the future′ session.

Peter Juni compared the statistical merits of the studies and the principles of non-inferiority, equivalence and superiority. He also highlighted some potential shortcomings in randomisation, study power, early termination and sub-group analyses.

Pieter Kappetein described the origins and practice of the SYNTAX scoring system before Antonio Colombo described its results in the very ′inclusive′ SYNTAX study of left main (LM) and/or 3-vessel disease patients. Twelve-month data analysed so far shows that PCI works as well as CABG for SYNTAX scores <22, with CABG superior for moderate (23-32) or serious (>33) disease.

Kevin Beatt explained that CARDia was designed on the basis that if optimal PCI with drug eluting stents (DES) could show statistical non-inferiority to CABG in diabetic patients, its less invasive nature would offer clinical superiority in practice. He compared the results for sub-groups and matched primary end points with SYNTAX data and concluded that PCI resulted in more non-fatal MIs and CABG caused more strokes, possibly due to technique or co-medication differences. Nico Pijls presented the FAME data on fractional flow reserve (FFR)-guided revascularisation versus current angiographic guidance.

FRAME suggests FFR use can help reduce composite endpoint failures by 30% and reduce mortality and MI at one year by 35% - as well as being cost-, stent- and contrast medium-sparing.

Patrick Serruys, representing the cardiologist viewpoint concluded that CABG remained first choice for 66% of revascularisation patients – a figure which surgeon Friedrich- Wilhelm Mohr agreed, before concluding that surgeons should strive to do even better for the SYNTAX <22 patients!