Stenting of the Left Main Artery vs. Bypass Surgery: Another Take

A large randomized trial surprisingly demonstrates superior 5-year outcomes for coronary-artery bypass surgery in patients with left main coronary artery disease.

For years, coronary-artery bypass grafting (CABG) has been the standard method for revascularization in patients with left main coronary artery disease. In NOBLE, a noninferiority study supported by a stent manufacturer, researchers randomized 1201 such patients to CABG or percutaneous coronary intervention (PCI); patients had stable or unstable angina or non–ST-elevation myocardial infarction.

In 5-year follow-up estimates, the primary composite endpoint — major adverse cardiac or cerebrovascular events (all-cause mortality, nonprocedural myocardial infarction, any repeat coronary revascularization, and stroke) — was more common after PCI than after CABG (hazard ratio [HR], 1.48), mainly driven by a higher rate of revascularization (HR, 1.5…

Reviewing Author

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

Leadership Positions in Professional SocietiesEuropean Society of Cardiology (Communication Committee); European Association of Percutaneous Cardiovascular Interventions (Chair, Web & Communication Committee)

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

Stenting of the Left Main Artery vs. Bypass Surgery: Another Take

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Reviewing Author