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Randomised controlled trial
Percutaneous coronary intervention has similar 5-year survival rates to coronary artery bypass grafting surgery for patients with unprotected left main artery disease
  1. Carlos Collet1,
  2. Patrick W Serruys2
  1. 1 Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Department of Cardiology, Imperial College London, London, UK
  1. Correspondence to Professor Patrick W Serruys, Westblaak 98, 3012 KM, Rotterdam, The Netherlands.; patrick.w.j.c.serruys{at}

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Commentary on: Mäkikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 2016;388:2743–2752.


An on-going debate is whether percutaneous coronary intervention (PCI) offers similar clinical results compared with coronary artery bypass grafting surgery (CABG) for patients with unprotected left main artery disease (ULMAD). Previously, the SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery  (SYNTAX) trial scrutinized the benefit of the first generation of drug-eluting stents in patients with multivessel disease and ULMAD. At 5 years, CABG was associated with improved clinical outcomes compared with PCI. Nonetheless, in patients with ULMAD and SYNTAX score <33, similar results were observed.1 The European and American guidelines agree upon the fact that in patients with ULMAD, CABG is the preferred treatment whereas PCI might be an alternative when the SYNTAX score …

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  • Competing interests PWS is a member of the international advisory board of Abbott Vascular.

  • Provenance and peer review Commissioned; internally peer reviewed.