Intervention in left main coronary artery disease
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
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Overview
Left main coronary artery stenosis is associated with poor patient outcomes secondary to the ischemia of the large area of the myocardium which it supplies. Traditionally, CABG was indicated for left main disease. The SYNTAX trial demonstrated non-inferiority of PCI to CABG in a subgroup of patients with low to intermediate SYNTAX score. This clinical trial suggests a possible indication for a PCI option for the treatment of left main disease. Subsequently, the PRECOMBAT trial was conducted to compare the two interventions in this particular subgroup. In 2016, two large trials results were published (EXCEL trial and NOBLE trial) to address the comparison of CABG and PCI in patients with left main disease and low to intermediate SYNTAX scores.
Left Main Disease Trials
Synopsis
| Clinical Trial | Year | Sample Size (N) | Patient Population | Follow-up Period | Primary Endpoint | PCI Intervention | CABG Intervention | Main Study Finding | Limitations |
|---|---|---|---|---|---|---|---|---|---|
| SYNTAX | ~1200 patients | 5 years | |||||||
| PRECOMBAT | ~600 patients | 5 years | Sirolimus DES | Traditional CABG
(with Cardiopulmonary Bypass) |
|||||
| EXCEL | ~2000 patients | 3 years | Everolimus DES | Significant number of off-pump procedures | |||||
| NOBLE | ~1200 patients | 5 years | Biolimus DES | Significant number of off-pump procedures |