- Question
- Is PCI with everolimus-eluting stents a noninferior alternative to coronary artery bypass grafting in patients with left main coronary artery disease of low or intermediate anatomical complexity?
- Design
- Randomized, open-label (unmasked), noninferiority trial funded by Abbott Vascular, with 1905 patients assigned to PCI or CABG. Anatomic complexity was assessed at the enrolling sites.
- Population
- Patients with obstructive left main coronary artery disease and low or intermediate anatomical complexity, defined as a SYNTAX score of 32 or lower by site assessment.
- Intervention
- Percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (948 patients).
- Control
- Coronary artery bypass grafting (CABG) (957 patients).
- Primary outcome
- Composite of death from any cause, stroke, or myocardial infarction at 3 years, with a noninferiority margin of 4.2 percentage points.
- Results
- At 3 years the primary end point occurred in 15.4% with PCI and 14.7% with CABG (difference 0.7 percentage points; upper 97.5% confidence limit 4.0 percentage points; P=0.02 for noninferiority; HR 1.00; 95% CI 0.79 to 1.26; P=0.98 for superiority). At 30 days, death, stroke, or myocardial infarction occurred in 4.9% with PCI and 7.9% with CABG (P=0.008 for superiority).
- Safety
- The composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years was 23.1% with PCI and 19.1% with CABG (P=0.10 for superiority).
- Conclusion
- In left main disease with low or intermediate SYNTAX scores, PCI with everolimus-eluting stents was noninferior to CABG for the composite of death, stroke, or myocardial infarction at 3 years.
- Why it matters
- It provided large-scale randomized evidence supporting PCI as an alternative to surgery in selected patients with left main coronary artery disease, reinforcing shared decision-making between the cardiology and surgical teams.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026