Summary
This pooled analysis of four randomised controlled trials (SYNTAX, PRECOMBAT, NOBLE, EXCEL) examined 4,394 patients with left main coronary artery disease to assess whether clinical outcomes after PCI versus CABG differed in patients presenting with versus without acute coronary syndrome. Patients with ACS had substantially higher mortality and spontaneous MI rates in the 30-day perioperative period; however, five-year outcomes for all-cause mortality were similar between treatment strategies in both ACS and non-ACS subgroups.
UK applicability
These findings provide evidence relevant to UK cardiovascular practice guidelines and treatment selection algorithms for patients with left main disease presenting acutely. The results support consideration of PCI as a viable alternative to surgery in select acute presentations, though applicability depends on local resource availability and operator expertise.
Key measures
All-cause death, cardiovascular death, spontaneous myocardial infarction, procedural myocardial infarction, stroke, repeat revascularisation; hazard ratios and Kaplan-Meier event rates through 5 years
Outcomes reported
The study compared five-year clinical outcomes including all-cause mortality, cardiovascular death, myocardial infarction, stroke, and repeat revascularisation between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with left main coronary artery disease, stratified by acute coronary syndrome presentation.
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