EuroPCR 2026 – DES-PCI and CABG Show Comparable Long-Term Outcomes for Left Main Revascularization

A meta-analysis of long-term data suggests that both drug-eluting stent percutaneous coronary intervention (DES-PCI) and coronary artery bypass grafting (CABG) are reasonable options for left main coronary revascularization in appropriately selected patients.

The findings support the growing role of DES-PCI in contemporary practice and emphasize the importance of multidisciplinary team-based decision-making when choosing the optimal revascularization strategy.

Randomised trials have investigated the optimal revascularisation strategy for patients with left main coronary artery disease, comparing percutaneous coronary intervention (PCI) using drug-eluting stents (DES) with coronary artery bypass grafting (CABG). In 2021, a meta-analysis of 4 trials − SYNTAX, PRECOMBAT, NOBLE and EXCEL – found no statistically significant difference in 5-year all-cause mortality between DES PCI and CABG.1 Long-term follow-up of these trials is now complete, providing the opportunity to evaluate the effects of DES PCI and CABG on mortality over an extended period.

An individual participant data meta-analysis of these trials was presented by Brian Bergmark. The meta-analysis included 10-year data for SYNTAX, PRECOMBAT and NOBLE, and 5-year data for EXCEL.

Results

• The meta-analysis included data from 4,394 patients.
• Rates of all-cause mortality did not differ between patients randomised to DES PCI (23.5%) or CABG (23.1%).
• There were no apparent differences between the treatments amongst various subgroups studied, including baseline SYNTAX score (≤22, 23–32 and ≥33).
• Similar mortality results for DES PCI (22.3%) and CABG (23.3%) were obtained when analysis was restricted to trials with 10-year follow up data.
• In landmark analyses of all 4 trials, results were similar for DES PCI and CABG in the 0–5-year and 5–10-year follow up time periods.

Key learnings

• There is no significant difference in mortality over 10 years of follow-up in patients with left main coronary artery disease considered suitable for revascularisation with DES PCI or CABG.
• These similar mortality rates were consistent across key clinical subgroups, and in both the 0–5-year and 5–10-year follow up time periods.

Conclusions and PCR recommendations

This meta-analysis of long-term data indicates that either DES PCI or CABG may be considered for left main revascularisation in patients who are deemed to be suitable for both approaches by a multidisciplinary team. These findings strengthen the role of DES PCI in contemporary practice and endorse the role of the multidisciplinary team in clinical decision-making processes.

Reference:

Sabatine MS, Bergmark BA, Murphy SA, et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. Lancet. 2021;398:2247−2257.