Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis

The use of percutaneous coronary intervention (PCI) for unprotected left main coronary artery stenosis is increasing but it remains unclear whether this approach is non-inferior to coronary artery bypass grafting (CABG). Both the Nordic-Baltic-British left main revascularisation study (NOBLE, n=1201) and Evaluation of an everolimus eluting stent versus coronary artery bypass surgery for effectiveness of left main revascularisation study (EXCEL, n=1905) randomised patients with severe left main coronary artery stenosis to PCI or CABG to address this question. Though similar, there are important differences in these studies’ design and results. Primary outcomes were defined as all cause death, stroke and non-procedural myocardial infarction (MI) in both trials with the addition of repeat revascularisation in NOBLE and post-procedural MI in EXCEL. Other study differences include intended duration of follow-up, non-inferiority margins, allowable coronary complexity, and stent type. The prevalence of distal left main stenosis was …