Dar Dr Topol,

Your question regarding the real merit of Syntax like trials seems to be a bit early. A good year has elapsed since the evaluation of the trial, and one  can see fundamental benefits on either modality. The chance for evaluation a given status of the coronaries simultaneously by the cardiologist and surgeon is a great breakthrough. This might be a great achievement and may serve the patients very well.

As a surgeon, I wish to note, that while the basic surgical practice (CABG) has not changed since the Green procedure (LIMA to LAD, 1970) and more and more arteries are being used for bypass surgery, in PCI practice one can observe an ever changing methodology (DES with different substances, bioabsorbable stents,etc) and also very serious complications: early, late thrombosis, clopidogrel resistency.

The effect of the SYNTAX trial will come a bit later, I think.

 The important aspect of the Syntax trial is to define the hitherto guessed "risk" for PCI in complex morphologies with the Syntax Score.

Interventional cardiologists have been doing this for a while by intuition and such a score adds to the decision making process.

The second aspect is that CABG vs PCI for Left main with 1 vessel disease was evaluated and it appears that this subsection can be safely treated with PCI at the same complication and outcome rates as CABG.  This might move Left main PCI from a classIII indication to Class 2b for a select subsect of patients.