Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary
drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients
with left main coronary artery disease are not clearly established.We randomly assigned
1905 patients with left main coronary artery disease of low or intermediate anatomical
complexity (according to assessment at the participating centers) to undergo either
PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group,
948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite
of death, stroke, or myocardial infarction.At 5 years, a primary outcome event had
occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in
the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], -0.9
to 6.5; P = 0.13). Death from any cause occurred more frequently in the PCI group
than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95%
CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular
death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, -1.4
to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points;
95% CI, -1.3 to 4.2) were not significantly different. All cerebrovascular events
were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage
points; 95% CI, -3.8 to 0), although the incidence of stroke was not significantly
different between the two groups (2.9% and 3.7%; difference, -0.8 percentage points;
95% CI, -2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI
than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to
10.0).In patients with left main coronary artery disease of low or intermediate anatomical
complexity, there was no significant difference between PCI and CABG with respect
to the rate of the composite outcome of death, stroke, or myocardial infarction at
5 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776.).
