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Updated: Aug 2, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Survival after PCI or CABG for left main stem coronary stenosis. A single institution registry from the NOBLE study
Truls Myrmel1, Anders Lamøy Bjøru2, Petter Cappelen Endresen1
1Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway.
Insights
Coronary artery disease patients treated with percutaneous coronary intervention (PCI) had significantly higher 10-year mortality than those treated with coronary artery bypass grafting (CABG). CABG demonstrated better long-term survival for left main coronary artery stenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left main coronary artery stenosis is a critical condition requiring revascularization.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are primary treatment options.
- Long-term outcomes comparing PCI and CABG for left main disease require further investigation.
Purpose of the Study:
- To compare 10-year mortality rates in patients with left main coronary artery stenosis treated with PCI versus CABG.
- To identify predictors of long-term mortality in this patient cohort.
Main Methods:
- Analysis of an all-comers registry of patients treated with PCI or CABG for left main stenosis (2010-2015).
- Inclusion of patients from the NOBLE trial and an institutional database.
- Long-term mortality follow-up until October 2020, with a maximum observation time of 9.9 years.
Main Results:
- Ten-year survival was 48% for PCI patients versus 80% for CABG patients.
- PCI was identified as the strongest independent predictor of mortality (HR = 2.5).
- Comorbidities including COPD, chronic kidney disease, and peripheral vascular disease predicted increased mortality.
Conclusions:
- Long-term life expectancy is shorter for patients with left main disease treated with PCI compared to CABG.
- CABG appears to be associated with superior survival outcomes in this patient population.
Abstract:
Objective. To analyze 10 years mortality in an all-comers registry of patients with left main coronary artery stenoses treated with either PCI or CABG. Design. Patients with left main coronary stenoses treated with either PCI or CABG in the period of the NOBLE trial (2010-2015) were all included in an institutional database and registry (University Hospital North Norway). Fifty-six of totally 429 patients were included in the randomized, multicenter and international NOBLE trail; 426 eligible patients from the trial and registry were analyzed for mortality on 20 October 2020. The longest observation time on this date was 3611 days (9.9 years); 205 patients were treated with PCI and 221 with CABG. The patients treated with PCI were 74 ± 10 years vs 68 ± 10 years (CABG). Also, on average the PCI patients had more comorbidities (lower ejection fraction, more peripheral artery disease, more often acute presentation). Results. Survival at the last observation date was 80% for CABG patients vs 48% for PCI. A Cox proportional hazards analysis found PCI to be the strongest independent predictor for mortality (HR = 2.5, 95% CI 1.7-3.7). Also, COPD, chronic kidney disease, age, peripheral vascular disease, cerebrovascular incidents and acute presentation were factor predicting increased 10 years mortality. Conclusion. These data indicate that life expectancy in the overall patient population is shorter for patient treated for left main disease with PCI than with CABG.
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