PATIENTS with left main coronary artery disease had similar long-term mortality outcomes whether treated with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) or coronary artery bypass grafting (CABG), according to a major meta-analysis presented at EuroPCR 2026.¹
Understanding Left Main Coronary Artery Disease
Left main coronary artery disease represents a particularly high-risk form of coronary artery disease, as the left main coronary artery supplies a large proportion of the myocardium.
CABG has traditionally been considered the standard treatment, though advances in DES technology have increasingly expanded the role of DES PCI.
EuroPCR Major Late-Breaking Analysis
The findings, presented as one of EuroPCR 2026’s major late-breaking trials, pooled long-term individual patient data from four landmark randomised studies: SYNTAX, PRECOMBAT, NOBLE, and EXCEL.
Investigators analysed outcomes from 4,394 patients to determine whether PCI or CABG offered superior long-term survival for left main coronary artery disease.
A previous 2021 meta-analysis of the same trials found no significant difference in five-year mortality between DES PCI and CABG.²
The latest analysis extended follow-up to 10 years for SYNTAX, PRECOMBAT, and NOBLE, while incorporating five-year data from EXCEL.
PCI and CABG Show Consistent Outcomes
Presented by Brian Bergmark, the updated individual participant data meta-analysis found all-cause mortality rates remained nearly identical between the two approaches. Mortality occurred in 23.5% of patients randomised to DES PCI, compared with 23.1% of those undergoing CABG.
Researchers also found no meaningful differences across important clinical subgroups, including patients with varying baseline SYNTAX scores. Similar findings were observed when the analysis was restricted to studies with full 10-year follow-up, with mortality rates of 22.3% for PCI and 23.3% for CABG.
The findings reinforce growing evidence that PCI may represent a viable alternative to surgery in carefully selected patients with left main coronary artery disease.
Multidisciplinary Decision-Making Remains Central
Investigators concluded that either DES PCI or CABG could reasonably be considered in patients deemed suitable for both procedures by a multidisciplinary heart team.
The results are expected to further strengthen the role of PCI in contemporary left main revascularisation strategies, while highlighting the importance of collaborative clinical decision-making.
Further research may help clarify which patient groups derive the greatest benefit from each approach over the longer term.
References
- Bergmark BA et al. Long-term mortality following PCI with DES vs. CABG for left main disease. Presentation. EuroPCR 2026, 19-22 May, 2026.
- Sabatine MS 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(10318):2247−57.
Featured image: Özgür Güvenç on Adobe Stock
