The results between coronary artery bypass grafting and myocardial coronary angioplasty has been the subject of controversy since the year 1979, when percutaneous technique was intriduced by Andreas Grüntzig [1].Since then, numerous randomized and multicenter studies were performed including: ERACI, EAST, GABI, CABRI, MASS, BARI, SIMA, LAUSANNE, RITA, TOULOUSE [2]. All studies have shown superiority of surgical revascularization versus percutaneous treatment, which consisted of substrate for abandoning balloon angioplasty and the emergence of a new era with stents.In this second phase, the results of angioplasty and stenting procedures are again compared, new studies were undertaken including: AWESOME, ARTS, SOS, ERACI, MASS, among others. Overall, the results in the first year were similar in both groups, but in 5 years, the reoperations in the stent group were higher due to multiple restenosis, which reaffirmed the surgical revascularization was the best option for this group of patients.With the emergence of drugs stents, new studies comparing surgery and the new generation of stents became necessary, now using chemicals to prevent restenosis.All prospective randomized studies were criticized, because they included only 5% of randomized susceptible patients. Research had serious distortions to include few patients with 3-vessel injury and critical injury of anterior proximal descending artery. These studies also excluded patients with left main coronary artery lesion [2].The results presented in the short-and medium-term have brought a lot of confusion because they were from a sample of only 5% of the cases, by assuming that in the real world results would be similar to clinical trials.The Synergy Between PCI with Taxus and cardiac surgery (SYNTAX) study, when looking more realistic approach proposed to compare surgical outcomes with new-generation percutaneous techniques including patients with 3-vessel lesions, trunk lesions or both. The study was designed as a prospective randomized controlled trial of more complex cases in which surgical or percutaneous treatment would be accepted by surgeons and hemodynamicists.The aim of this study was to demonstrate the non-inferiority of surgical versus percutaneous treatment, outcomes of interest to all participants of this scientific study.85 sites were selected, with 62 European and 23 from U.S. Patients with arteries smaller than 1.5 mm or obstructions below 50% were not included in the study [3].It was established that the sponsors would collect data and perform biostatistics assessment, and the writing and publication of the results would be provided by the researchers. The study was approved by the Research Ethics Committees of all participating hospitals. The study sponsor was Boston Scientific Corp., with a cost of $ 50 million.The patients who were initially considered for the study were 3,075 cases, 1,275 were rejected for entry in the register of randomization by the complexity of the lesions. Of these, 1077 were directly surgically treated and only 198 we...
