Stable coronary disease: medical therapy versus percutaneous coronary intervention versus surgery

This chapter describes the use of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial in reducing uncertainty in the decision between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) in complex coronary heart disease. Discussing the criticisms of major randomized trials such as the Bypass Angioplasty Revascularization Investigation (BARI) and Coronary Angioplasty versus Bypass Revascularization Investigation (CABRI) trials, the chapter explores the clinical evidence supporting decision-making between medical, percutaneous, and surgical-based revascularization therapy, the increasing requirements for a more individualized assessment of patients undergoing revascularization, and reviews the clinical tools currently available to assist in this decision-making process.