Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis

Yasir Taha, Rajan A.G. Patel, Jayant Bagai, Rajesh Sachdeva, Gautam Kumar, Anand Prasad, Sandeep Nathan, Timir K. Paul

Research output: Contribution to journalReview article

Abstract

Purpose of Review: This article reviews the latest data on unprotected left main (ULM) percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery, with a focus on the NOBLE and EXCEL trials. Recent Findings: In EXCEL trial, the primary endpoint at 3 years was 15.4% in the PCI group and 14.7% in the CABG group (p = 0.02 for non-inferiority of PCI versus CABG). In NOBLE, the primary endpoint at 5 years was 28% and 18% for PCI and CABG, respectively (HR 1.51, CI 1.13–2.0, which did not meet the criteria for non-inferiority of PCI to CABG; p for superiority of CABG was 0.0044). Higher repeat revascularization and non-procedural myocardial infarction were noted in PCI group but there was no difference in all-cause or cardiac mortality between the two groups. Summary: A heart team approach with appropriate patient selection, careful assessment of LM lesions, and meticulous procedural technique makes PCI a valid alternative to CABG for ULM stenosis.

Original languageEnglish (US)
Article number27
JournalCurrent Cardiology Reports
Volume21
Issue number5
DOIs
StatePublished - May 1 2019
Externally publishedYes

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Keywords

  • Coronary artery bypass graft
  • Left main
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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