Related Experiment Video
Updated: Dec 21, 2025
04:30
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
26.1K
In unprotected left main CAD, revascularization with PCI and DES increased risk for MACCE vs CABG at 5 years
Saraschandra Vallabhajosyula1, Malcolm R Bell1
1Mayo Clinic, Rochester, Minnesota, USA (S.V., M.R.B.).
Annals of Internal Medicine
|May 19, 2020
Insights
Updated 5-year outcomes from the NOBLE trial show percutaneous coronary angioplasty is non-inferior to coronary artery bypass grafting for unprotected left main stenosis treatment.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Cardiac surgery
Background:
- Unprotected left main coronary artery stenosis is a high-risk condition.
- Percutaneous coronary angioplasty (PCI) and coronary artery bypass grafting (CABG) are primary treatment options.
- The NOBLE trial aimed to compare long-term outcomes of PCI versus CABG.
Purpose of the Study:
- To compare the 5-year efficacy and safety of PCI versus CABG in patients with unprotected left main coronary artery stenosis.
- To provide updated long-term data for clinical decision-making.
Main Methods:
- Randomized, multicenter, non-inferiority trial.
- Included patients with unprotected left main coronary artery stenosis.
- Assessed outcomes at 5 years post-intervention.
Main Results:
- The primary composite endpoint occurred in 22.0% of PCI patients and 17.8% of CABG patients (hazard ratio, 1.27; 95% CI, 0.92-1.76).
- PCI was found to be non-inferior to CABG.
- No significant differences in rates of death, stroke, or myocardial infarction between groups.
Conclusions:
- Percutaneous coronary angioplasty is a safe and effective alternative to coronary artery bypass grafting for treating unprotected left main coronary artery stenosis at 5 years.
- These findings support PCI as a viable treatment option, offering similar long-term outcomes to CABG.
Abstract
Source Citation:
Holm NR, Mäkikallio T, Lindsay MM, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet. 2019;395:191-9. 31879028.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
173
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
173
01:28Acute Coronary Syndrome IV: Interprofessional Care
161
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
161
01:30Acute Coronary Syndrome I: Introduction
564
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
564
01:17Ischemic Heart Disease: Overview
2.6K
Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
2.6K
01:26Angina IV: Management
184
IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
184
01:27Peripheral Artery Disease III: Interprofessional Care
175
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
175