VIDEO: Debate continues on PCI vs. CABG for left main CAD

WASHINGTON — In this video, Cardiology Today’s Intervention chief medical editor Deepak L. Bhatt, MD, MPH, discusses similarities and differences between the EXCEL and NOBLE trials, both of which studied outcomes with PCI vs. CABG and were presented at TCT 2016.

In EXCEL, treatment of patients with left main CAD and low or intermediate SYNTAX scores with everolimus-eluting stents resulted in similar rates of death, stroke or MI at 3 years compared with CABG. In NOBLE, PCI with a drug-eluting stent was inferior to CABG for the outcome of MACCE at 5 years in patients with angina or non-STEMI.

“I'm sure there will be ... discussions in the interventional community and the cardiac surgery community, as far as which trial was better [and] ... which one is more representative of U.S. sites and U.S. practice. But, I think there were some common themes, ... [and there were] signals in both trials that, with longer durations of follow-up with respect to the endpoint of MI, CABG was better than PCI,” Bhatt, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, told Cardiology Today’s Intervention.

While there may be a professional divide on whether PCI or CABG is better suited for patients with left main disease, Bhatt said decisions should be made with the heart team on an individual basis to determine which treatment is best.

“I think there are two good options for left main disease, PCI and CABG, but exactly which one to use depends on the patient's risk. ... Integrating all [of those] data in a heart team approach will provide the best outcomes for our patients,” he said.