Long-term mortality following PCI with DES vs. CABG for left main disease

Major LBT from EuroPCR 2026

Summary

This major late-breaking trial from EuroPCR 2026 presents a landmark patient-level meta-analysis comparing PCI with drug-eluting stents (DES) versus CABG for left main coronary artery disease. Combining long-term data from the EXCEL, NOBLE, PRECOMBAT, and SYNTAX trials, the analysis found remarkably similar mortality outcomes between the two strategies at both 5 and 10 years.
David Hildick-Smith and Brian Bergmark discuss how these findings challenge traditional assumptions about the long-term survival advantage of surgery and what they mean for heart team decision-making.

This interview was filmed at EuroPCR 2026: see more videos here.

“Long-term follow-up comparing DES PCI and CABG in patients with left main disease is now complete, providing the opportunity to evaluate their effects on outcomes over an extended period,” explained Brian A. Bergmark (Brigham and Women’s Hospital, Harvard Medical School - Boston, USA) as he discussed the rationale behind a new meta-analysis of four randomised trials.

Individual patient data (n=4,394) on all-cause mortality were pooled from SYNTAX, PRECOMBAT, NOBLE and EXCEL, which randomised patients with left main disease considered suitable for either PCI or CABG. The meta-analysis included 10-year data for SYNTAX, PRECOMBAT and NOBLE, and 5-year data for EXCEL.

Rates of all-cause mortality did not differ between patients randomised to PCI or CABG (23.5% vs. 23.1%; HR 1.04; 95% CI 0.90–1.19; p=0.62).

Bayesian analysis indicated a 5.0% probability that the mortality difference between PCI and CABG was ≥2.5% over 10 years, and there were no apparent differences between the treatments for various subgroups, including baseline SYNTAX score (<22, 23–32 and ≥33).

Furthermore, a similar result was obtained when analysis was restricted to trials with 10-year follow-up (22.3% vs. 23.3%; HR 0.94; 95% CI 0.80–1.12; p=0.5), and results were also confirmed in landmark analyses of all four trials at 0–5 and 5–10-year timepoints.

Dr Bergmark concluded: “The results of this long-term meta-analysis indicate that either PCI or CABG may be considered for left main revascularisation in patients deemed appropriate for either approach by a multidisciplinary team.”

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