- Question
- To determine whether percutaneous coronary intervention (PCI) with drug-eluting stents is noninferior to coronary-artery bypass grafting (CABG) in patients with three-vessel or left main coronary artery disease.
- Design
- Randomized 1:1, open-label (no masking), noninferiority trial of 1800 patients. Patients for whom only one of the two strategies was suitable were entered into parallel nested CABG or PCI registries.
- Population
- Previously untreated patients with three-vessel disease, left main disease, or both, in whom the local cardiac surgeon and interventional cardiologist judged that equivalent anatomical revascularization could be achieved with either treatment.
- Intervention
- PCI with drug-eluting stents (TAXUS stent).
- Control
- Coronary-artery bypass grafting (CABG).
- Primary outcome
- Major adverse cardiac or cerebrovascular event (MACCE) within 12 months after randomization, defined as death from any cause, stroke, myocardial infarction, or repeat revascularization.
- Results
- MACCE at 12 months were more frequent with PCI (17.8% vs. 12.4% with CABG; P=0.002), largely because of more repeat revascularization (13.5% vs. 5.9%; P<0.001), so the noninferiority criterion was not met. Death and myocardial infarction were similar between groups.
- Safety
- Stroke was more frequent with CABG (2.2% vs. 0.6% with PCI; P=0.003).
- Conclusion
- CABG remained the standard of care for three-vessel or left main disease, as it achieved lower rates of MACCE at 1 year than PCI.
- Why it matters
- It established surgery as the reference strategy in complex coronary disease and underpinned the use of anatomical complexity in choosing between PCI and surgery through Heart Team discussion.
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 7, 2026