PCI and CABG are equal in left main CAD

With a median follow-up of 11.3 years, the PRECOMBAT trial showed that percutaneous coronary intervention (PCI) with sirolimus-eluting stents was non-inferior to coronary-artery bypass grafting (CABG) among patients with severe left main disease.

Dr Duk-Woo Park (Asan Medical School, South Korea) presented the results of the open-label Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease (PRECOMBAT) trial [1]. PRECOMBAT was the first randomised study to compare PCI (n=300) with CABG (n=300) in patients with left main coronary artery disease. The results were simultaneously published online in Circulation [2].

At 10 years, there was no difference between the 2 groups; the primary composite endpoint of all-cause mortality, myocardial infarction, stroke, or ischaemia-driven revascularisation occurred in 29.8% of patients treated with PCI and 24.7% of patients in the CABG surgery group (HR 1.25; 95% CI 0.93-1.69). However, looking at individual components, the rate of revascularisation was significantly higher in patients treated with PCI (16.1% vs 8.0%; HR 1.98; 95% CI 1.21-3.21).

The study was not powered for clinical outcomes at 10 years. Dr Park cautioned that the results should be considered hypothesis-generating only and pointed out that the open-label nature of this study may have influenced some of the non-fatal outcomes. Further research is warranted for data concerning extended follow-up.

1. 
   
   1. Park S-J, et al. Abstract 410-14. ACC/WCC 28-30 March 2020.
   2. Park DW, et al. Circulation. 2020. DOI:10.1161/CIRCULATIONAHA.120.046039.

Posted on 8 September 202031 January 2024