|Authors: Mack M and Holmes DR., Lancet 2016 Oct 31;
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, 1.50). PCI was associated with more nonprocedural myocardial infarctions (HR, 2.88) and showed a nonsignificant trend towards higher risk for stroke (5%; CABG, 2%). All-cause mortality did not differ by treatment group.