Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis

Curr Cardiol Rep. 2019 Mar 18;21(5):27. doi: 10.1007/s11886-019-1113-0.

Abstract

Purpose of review: This article reviews the latest data on unprotected left main (ULM) percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery, with a focus on the NOBLE and EXCEL trials.

Recent findings: In EXCEL trial, the primary endpoint at 3 years was 15.4% in the PCI group and 14.7% in the CABG group (p = 0.02 for non-inferiority of PCI versus CABG). In NOBLE, the primary endpoint at 5 years was 28% and 18% for PCI and CABG, respectively (HR 1.51, CI 1.13-2.0, which did not meet the criteria for non-inferiority of PCI to CABG; p for superiority of CABG was 0.0044). Higher repeat revascularization and non-procedural myocardial infarction were noted in PCI group but there was no difference in all-cause or cardiac mortality between the two groups. A heart team approach with appropriate patient selection, careful assessment of LM lesions, and meticulous procedural technique makes PCI a valid alternative to CABG for ULM stenosis.

Keywords: Coronary artery bypass graft; Left main; Percutaneous coronary intervention.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Coronary Artery Bypass*
  • Coronary Stenosis / surgery*
  • Drug-Eluting Stents
  • Humans
  • Percutaneous Coronary Intervention*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome