What it is
Percutaneous coronary intervention (PCI) with drug-eluting stents is widely used for disease of the left main coronary artery, the vessel that feeds most of the left side of the heart, but long-term outcomes against coronary artery bypass grafting (CABG) in everyday practice remain poorly characterised. The authors compared long-term all-cause mortality after PCI or CABG in Asian patients with unprotected left main disease, using prospectively collected data from the multicentre IRIS-MAIN registry at 46 hospitals in South Korea, India, Japan, Indonesia and Malaysia. Of 6,900 patients enrolled between 2003 and 2024, 5,379 underwent revascularisation by PCI with drug-eluting stents (3,836) or CABG (1,543) and were analysed. Median follow-up across the registry was 10.0 years. Using a target trial emulation framework and propensity-score overlap weighting to adjust for measured baseline differences, they found no statistically detectable difference in 10-year weighted mortality between the two (24.0% against 22.9%; hazard ratio 1.00, 95% CI 0.87-1.14). The authors state that the confidence interval does not exclude a benefit or harm with either strategy.
Why it matters
Over a decade in routine Asian practice, stents and bypass surgery showed no detectable survival difference, though a registry of this kind cannot show that the two are equivalent. For patients they consider suitable for either strategy, the authors suggest a multidisciplinary Heart Team discussion might help patients and clinicians weigh those trade-offs, and note that the registry enrolled adults with a left main stenosis of at least 50% as judged visually on angiography, treated with PCI, CABG or medical therapy alone.
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Filed underCoronary Interventions and Diagnostics, Cardiac and Coronary Surgery Techniques, Cardiac Imaging and Diagnostics
