NOBLE: 5-Year Risk of PCI vs. CABG in Left Main CAD
Despite similar mortality, the five-year risk of major adverse events was higher after percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for the treatment of unprotected lower main coronary artery disease (CAD), according to the results of the NOBLE Trial presented Oct. 31 at TCT 2016 and simultaneously published in The Lancet.
Evald H. Christiansen, MD, PhD, et al., evaluated the non-inferiority of PCI versus CABG in a prospective, randomized trial of 1201 patients with stable angina pectoris, unstable angina pectoris or non-ST elevation myocardial infarction. The primary endpoint was the composite of major adverse cardiac and cerebrovascular events, including death, myocardial infarction (MI), repeat revascularization and stroke at two years, which was ultimately extended to three years due to lower than expected endpoint rates.
The results of the study showed that CABG was superior to PCI in patients with left main CAD. Comparing PCI with CABG, five-year estimates were 11.6 vs. 9.5 percent for all-cause mortality; 6.9 vs. 1.9 percent for non-procedural MI; 16.2 vs. 10.4 percent for any revascularization; and 4.9 vs. 1.7 percent for stroke.
According to Christiansen, “the low mortality following treatment in both groups demonstrates that modern revascularization techniques can lead to excellent survival in stable left main CAD patients.” He adds that “the increased rates of non–procedural MI, repeat revascularization and stroke associated with PCI are important considerations in selecting the optimal treatment for individual patients.”
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