Taha, Yasir; Patel, Rajan A. G.; Bagai, Jayant; Sachdeva, Rajesh; Kumar, Gautam; Prasad, Anand; Nathan, Sandeep; Paul, Timir K.
Abstract
Purpose of ReviewThis 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 FindingsIn EXCEL trial, the primary endpoint at 3years 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 5years 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.SummaryA 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.
