Summary
This pooled analysis of four major randomised trials (SYNTAX, PRECOMBAT, NOBLE, EXCEL) comprising 4,394 patients examined clinical outcomes after PCI versus CABG in patients with left main coronary artery disease, with particular focus on the understudied subgroup presenting with acute coronary syndrome (33% of cohort). Patients presenting with ACS had substantially higher short-term mortality risk but similar long-term all-cause mortality rates between treatment strategies, and higher rates of spontaneous myocardial infarction through 5 years regardless of revascularisation method.
Regional applicability
These findings inform clinical decision-making in UK cardiology practice regarding revascularisation strategy selection in left main coronary disease with ACS. The results support consideration of either PCI or CABG as viable options for appropriately selected patients, though the elevated risk profile of ACS presentations warrants careful patient counselling and risk stratification.
Key measures
Kaplan-Meier event rates through 5 years, Cox model hazard ratios, all-cause mortality, cardiovascular death, spontaneous myocardial infarction, procedural myocardial infarction, stroke, repeat revascularisation
Outcomes reported
The study compared clinical outcomes through 5 years after percutaneous coronary intervention (PCI) with drug-eluting stents versus coronary artery bypass graft (CABG) surgery in patients with left main coronary artery disease, stratified by acute coronary syndrome (ACS) status. Primary outcome was all-cause death; secondary outcomes included cardiovascular death, myocardial infarction, stroke, and repeat revascularisation.
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