CBS - The 16th Left Main & Coronary Bifurcation Summit, CBS2024

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Left Main & Coronary Bifurcation Summit (CBS) was founded in 2006 as a think tank dedicated to the treatment of left main and coronary bifurcation lesions. CBS aims to improve cardiological care by refreshing fundamental researches, clinical trials, yearly published guidelines, emerged ideas and case-based discussion.

Association and Affiliations
- Organized by
  
  Nanjing Heart Center
  
  Asian Bifurcation Club (ABC)
  
  Nanjing First Hospital, Nanjing Medical University
- Co-organized by
  
  Chinese Society of Cardiology (CSC)
  
  Capacity Building and Continuing Education Center,National Health and Family Planning Commission (CBCEC)
  
  American Society for Cardiovascular Angiography and Interventions (SCAI)
  
  Asian Heart Society (AHS)
Contact Us
- Registration Administration of Domestic Representatives
  
  Hongjuan Peng : +86-13913895477
  
  Haimei Xu +86-13914736846
  
  cbsnj@cbsmd.cn
- Registration Administration of Overseas Representatives
  
  Ling Lin : +86 (25) 52271398
  
  +86-13951884596
  
  cbs@cbsmd.cn
- Management of Challenging Cases
  
  Yingying Zhao :+86-13815408517
  
  sub@cbsmd.cn
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CBS2019 Congress Secretariat, Nanjing First Hospital, Building No.9 68# Changle Road, Nanjing, China

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SCIENTIFIC LIBRARY

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Research Paper

> Acute Coronary Syndrom

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> Stenting Left Main

> Transcatheter Aortic Valve Replacement

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HOME | SCIENTIFIC LIBRARY | Stenting Left Main

Stenting Left Main

Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial Bayesian Interpretation of the EXCEL Trial and Other Randomized Clinical Trials of Left Main Coronary Artery Revascularization Two-year outcomes of everolimus vs. paclitaxel-eluting stent for the treatment of unprotected left main lesions: a propensity score matching comparison of patients included in the French Left Main Taxus (FLM Taxus) and the LEft MAin Xience (LEMAX) registries Usefulness of the SYNTAX score II to validate 2-year outcomes in patients with complex coronary artery disease undergoing percutaneous coronary intervention: A large single-center study Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis A Systematic Review and Meta-analysis What Is the Optimal Revascularization Strategy for Left Main Coronary Stenosis?

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Clinical Trial2016 Dec 3;388(10061):2743-2752.

JOURNAL：Lancet. Article Link

Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial

Mäkikallio T, Holm NR, NOBLE study investigators et al. Keywords: PCI; CABG; noninferiority

ABSTRACT

BACKGROUND - Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease.

METHODS - In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1·35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651.

FINDINGS - Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 1·48 (95% CI 1·11-1·96), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0·0066). As-treated estimates were 28% versus 19% (1·55, 1·18-2·04, p=0·0015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (1·07, 0·67-1·72, p=0·77) for all-cause mortality, 7% versus 2% (2·88, 1·40-5·90, p=0·0040) for non-procedural myocardial infarction, 16% versus 10% (1·50, 1·04-2·17, p=0·032) for any revascularisation, and 5% versus 2% (2·25, 0·93-5·48, p=0·073) for stroke.

INTERPRETATION - The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease.

FUNDING - Biosensors, Aarhus University Hospital, and participating sites.

Abstract

Recommended Article

Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial

ABSTRACT