Left Main Coronary Artery Disease: PCI vs. CABG

New data bring new controversy.

Revascularization for symptomatic significant left main (LM) coronary artery disease (CAD) has been the standard of care for more than 30 years. More recent advances in drug-eluting stents have begun to level the playing field between percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG), with the less invasive approach preferred when data demonstrate similar outcomes. However, randomized trial comparisons between PCI and CABG for LM disease have not demonstrated a conclusive winner.

The most recent study, NOBLE, partially funded by a stent manufacturer (Lancet 2019 Dec 23; [e-pub]; NCT01496651) provided 5-year results for 1201 patients with symptomatic LM stenoses (>50%) who had been randomized to PCI or CABG. …

Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)