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Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Stenosis: A Meta-Analysis of Randomized Trials Sex differences in left main coronary artery stenting: Different characteristics but similar outcomes for women compared with men Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location Expansion or contraction of stenting in coronary artery disease? EXCELling in Left Main Intervention Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study Complex PCI procedures: challenges for the interventional cardiologist Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease Impact of coronary anatomy and stenting technique on long-term outcome after drug-eluting stent implantation for unprotected left main coronary artery disease
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Editorial2019 Oct 12;394(10206):1299-1300.

JOURNAL：Lancet. Article Link

Expansion or contraction of stenting in coronary artery disease?

Taggart DP, Pagano D. Keywords: PCI vs CABG; left main

ABSTRACT

In the past four decades, more than 20 trials of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have tested whether iterative technical advances in PCI have made it as effective as CABG in patients with stable coronary artery disease. The clinical relevance of most of these trials to real-world practice has, however, been plagued by three issues.


First, by largely enrolling highly selected patients with low-severity coronary artery disease, the trials were inherently biased towards more favourable outcomes for PCI. Second, by limiting follow-up to a few years, the trials hid the accelerating divergence in survival benefit of CABG. Third, even in relatively contemporary trials, surgical patients received substantially inferior medical therapy, thereby mitigating the overall benefits of CABG. 
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