scholarly journals Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial

The Lancet ◽  
2016 ◽  
Vol 388 (10061) ◽  
pp. 2743-2752 ◽  
Author(s):  
Timo Mäkikallio ◽  
Niels R Holm ◽  
Mitchell Lindsay ◽  
Mark S Spence ◽  
Andrejs Erglis ◽  
...  
2019 ◽  
Vol 69 (12) ◽  
pp. 3600-3604
Author(s):  
Silviu Paul Trasca ◽  
Cristina Florescu ◽  
Venera Cristina Dinescu ◽  
Ileana Puiu ◽  
Sorin Nicolae Dinescu ◽  
...  

The aim of our study was to assess the percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of the left main coronary artery disease. The study was a prospective, analytical, observational descriptive one, it included a total number of 83 patients, consecutively included in order to avoid bias, for a period of three years between October 2012 and December 2015. The follow-up was performed for 3 years, initially at one month, then at an interval of three to six months. The primary clinical endpoint was mortality of any cause of the patients included in the study. Other main objectives assessed in our study were symptomatic ischemic heart disease manifested with angina pectoris, the need for myocardial revascularization, nonfatal myocardial infarction, and reduction of left ventricular ejection fraction. In patients with LMCAD, we noticed an increase in mortality in patients with PCI vs. CABG, recurrence of angina pectoris, acute myocardial infarction, myocardial revascularization, and depression of the ejection fraction of the left ventricle. In conclusion, the treatment of left main coronary artery disease by using coronary artery bypass grafting is superior to treatment using percutaneous coronary angioplasty.


2020 ◽  
Vol 15 ◽  
Author(s):  
Marjan Jahangiri ◽  
Krishna Mani ◽  
Martin T Yates ◽  
Justin Nowell

There have been several investigations comparing the efficacy of percutaneous coronary intervention and coronary artery bypass grafting surgery for treatment of left main stem disease. This includes the Evaluation of XIENCE versus Coronary Artery Bypass Graft Surgery for Effectiveness of Left Main Revascularizaton (EXCEL) trial, which has garnered significant controversy surrounding its experimental design and reporting of its results. The authors review the methodology, results, caveats and statements on the EXCEL trial. They also review the other trials in the management of left main stem disease comparing percutaneous coronary intervention with coronary artery bypass grafting, as well as the SYNTAX score and its role in future guidelines for revascularisation. These findings have significant implications for current practice, influencing the growing role for multidisciplinary team meeting and allowing clinicians and patients to make the right choice.


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