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Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting Access Site and Outcomes for Unprotected Left Main Stem Percutaneous Coronary Intervention: An Analysis of the British Cardiovascular Intervention Society Database Self-expandable sirolimus-eluting stents compared to second-generation drug-eluting stents for the treatment of the left main: A propensity score analysis from the SPARTA and the FAILS-2 registries Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease Unprotected Left Main Disease: Indications and Optimal Strategies for Percutaneous Intervention Outcomes of patients with and without baseline lipid-lowering therapy undergoing revascularization for left main coronary artery disease: analysis from the EXCEL trial Radial versus femoral artery access in patients undergoing PCI for left main coronary artery disease: analysis from the EXCEL trial Impact of large periprocedural myocardial infarction on mortality after percutaneous coronary intervention and coronary artery bypass grafting for left main disease: an analysis from the EXCEL trial Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club

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.