Management of severe coronary artery disease (CAD), defined as multivessel disease with or without significant left main coronary artery (LMCA) involvement, remains an important topic for debate. Although coronary artery bypass graft (CABG) surgery has been the historical mainstay of treatment, improvements in the field of interventional cardiology, particularly following the introduction of drug-eluting stents (DES), have led to an expansion of the use of percutaneous coronary intervention (PCI) in patients with complex coronary anatomy including severe three-vessel CAD. In view of these changes in the modern DES era, the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was designed to investigate the optimal revascularisation strategy for patients with severe CAD. In this article, the SYNTAX trial is analysed in depth and the implications of its results for contemporary clinical management are discussed in order to ascertain whether PCI can be used appropriately in the management of patients with complex CAD or if CABG should remain the standard of care in most cases of severe CAD.
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