In unprotected left main CAD, revascularization with PCI and DES increased risk for MACCE vs CABG at 5 years

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.