The benefits of 2nd generation drug-eluting stents (DES) are being compared with Coronary artery bypass graft surgery (CABG), looking to achieve a safe, effective, less invasive and as complete as possible revascularization. As background of SYNTAX, the stent thrombosis (ST) with Taxus, reached 25% of the events in the group of intervention (PCI), so that the appearance of the 2nd generation DES with greater safety and reduced ischemic events gave new hope to this therapy.

The BEST is a randomized, non-inferiority study, which compared 448 patients assigned to PCI versus 442 assigned to CABG. Patients with at least two severe lesions (>50%) were included in different vessels. We excluded patients with severe LMCA disease.

The primary endpoint was a composite of death, myocardial infarction (MI) or revascularization of treated vessel at 2 years of randomization. Secondary endpoints were one composed of safety (death, MI, stroke, or any new revascularization) plus the components of the primary individualized, intrastent thrombosis and greater or fatal bleeding.

The primary endpoint at 2 years was similar (PCI 11% versus CABG 7.9%) but at 4.6 years occurred more frequently in PCI (PCI 15.3% versus CABG 10.6%, HR 1.47; CI 95%, 1.01 to 2.13; p = 0.04) and more significantly in diabetics (PCI 19.2% versus CABG 9.1%, p = 0.007). The composite secondary endpoint was PCI 19.9%.

Original title: Trial of Everolimus-Eluting Stents or Bypass Surgery for Coronary Disease. The BEST Trial. 
Reference: Seung-Jung Park, M.D., Ph.D., Jung-Min Ahn, M.D., Young-Hak Kim, M.D. et al. N Engl J Med 2015; 372:1204-1212 March 26, 2015.