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Updated: Dec 5, 2025

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Tale of Two sons - Nobelar and Excelar and the blurring edge between them

A Mohammed Idhrees1

  • 1Cardiovascular and Thoracic Surgeon, Institute for Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospitals), Chennai, 600026 India.

Indian Journal of Thoracic and Cardiovascular Surgery
|October 16, 2020
PubMed

Insights

Percutaneous coronary interventions (PCI) are not yet proven superior to coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). An objective heart-team approach is needed for optimal patient care.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Left main coronary artery disease (LMCAD) poses significant prognostic risk due to the large myocardial territory involved.
  • Coronary artery bypass grafting (CABG) has historically been the gold standard treatment for LMCAD.

Purpose of the Study:

  • To evaluate the current evidence comparing percutaneous coronary interventions (PCI) and CABG for LMCAD.
  • To discuss the role and implementation of the heart-team approach in managing LMCAD.

Main Methods:

  • Review of recent major clinical trials (e.g., NOBEL, EXCEL) comparing PCI and CABG for LMCAD.
  • Discussion on the practical application and effectiveness of the heart-team approach in real-world settings.

Main Results:

  • Contradictory results from recent trials suggest PCI is not definitively superior to CABG for LMCAD.
  • The extent and manner of heart-team approach implementation in clinical practice remain unclear.

Conclusions:

  • The superiority of PCI over CABG for LMCAD remains unproven.
  • There is a need for a more objective and standardized heart-team approach in managing LMCAD patients.

Keywords:
Coronary artery bypass grafting (CABG)Heart-teamLeft main coronary artery disease (LMCAD)Percutaneous coronary intervention (PCI)

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