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Stenting Left Main

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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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