TABLE 2

Major CABG trials in left main coronary artery disease

StudyYearComparisonPrimary end pointKey findings
PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease)152011CABG vs PCI (sirolimus-eluting stents)MACCE (death from any cause, myocardial infarction, stroke, or ischemia-driven target-vessel revascularization)No significant difference in primary end point at 2 years
Higher ischemia-driven target-vessel revascularization in PCI group (9% vs 4.2%)
SYNTAX left main coronary artery subgroup162014CABG vs PCI (paclitaxel-eluting stents)Composite MACCE (all-cause mortality, stroke, myocardial infarction, and repeat revascularization)No significant difference in primary end point at 5 years
Increased stroke in CABG arm (4.3% vs 1.5%), higher repeat revascularization in PCI arm (26.7% vs 15.5%), and higher MACCE at 5 years in PCI with SYNTAX score ≥ 33 (46.5% vs 29.7%)
EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization)172019CABG vs PCI (everolimus-eluting stents)Composite of death, stroke, myocardial infarctionPCI was noninferior to CABG for primary end point at 3 years, survival curves favored CABG at 5 years (22.0% vs 19.2%), and ischemia-driven revascularization was more frequent after PCI (16.9% vs 10%)
NOBLE (Nordic-Baltic-British Left Main Revascularization)182020CABG vs PCIComposite MACCE (all-cause mortality, nonprocedural myocardial infarction, repeat revascularization, and stroke)CABG superior to PCI
Lower MACCE for CABG (19% vs 28%) at 5 years, driven by lower nonprocedural myocardial infarction (3% vs 8%) and lower repeat revascularization in CABG patients (10% vs 17%)

  • CABG = coronary artery bypass grafting; MACCE = major adverse cardiac or cerebrovascular events; PCI = percutaneous coronary intervention; SYNTAX = Synergy Between PCI With Taxus Stents and Cardiac Surgery