- Question
- Is percutaneous coronary intervention (PCI) non-inferior to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery stenosis?
- Design
- Prospective, randomised 1:1, open-label, non-inferiority trial conducted in 36 centres in northern Europe. A total of 1201 patients were randomised (598 to PCI and 603 to CABG), with follow-up of up to 5 years.
- Population
- Patients with left main coronary artery disease presenting with stable angina, unstable angina or non-ST-elevation myocardial infarction. Patients with ST-elevation myocardial infarction within 24 hours, those considered too high risk for CABG or PCI, and those with expected survival under 1 year were excluded.
- Intervention
- Revascularisation by percutaneous coronary intervention (PCI) with stenting.
- Control
- Coronary artery bypass grafting (CABG).
- Primary outcome
- Major adverse cardiac or cerebrovascular events (MACCE): a composite of all-cause mortality, non-procedural myocardial infarction, any repeat revascularisation and stroke. Non-inferiority required the upper limit of the 95% CI of the HR not to exceed 1.35.
- Results
- At 5 years, Kaplan-Meier estimates of MACCE were 29% with PCI and 19% with CABG (HR 1.48; 95% CI 1.11-1.96), so non-inferiority was not met and CABG was significantly better (p=0.0066). All-cause mortality was similar (12% vs 9%; HR 1.07; 95% CI 0.67-1.72), whereas non-procedural myocardial infarction was higher with PCI (7% vs 2%; HR 2.88; 95% CI 1.40-5.90).
- Conclusion
- PCI did not meet non-inferiority to CABG for left main disease, and the findings suggest that surgery might be the better option.
- Why it matters
- The trial provided randomised evidence supporting surgery as the reference treatment for left main disease and fuelled the debate on the role of PCI in this setting.
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