Kindi Hamood Al, Samaan Amir, Hosny Hatem
Aswan Heart Centre, Aswan, Egypt.
Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
Glob Cardiol Sci Pract. 2018 Mar 14;2018(1):3. doi: 10.21542/gcsp.2018.3.
Left main coronary artery (LMCA) disease is associated with increased morbidity and mortality. Coronary artery bypass grafting surgery (CABG) has always been the standard revascularization strategy for this group of patients. However, with the recent developments in stents design and medical therapy over the past decade, several trials have been designed to evaluate the safety and efficacy of percutaneous coronary intervention (PCI) as an alternative to CABG surgery in patients with LMCA disease. Recently, the results of two major trials, EXCEL and NOBLE, comparing CABG versus PCI in this patient population have been released. In fact, the results of both trials might appear contradictory at first glance. While the EXCEL trial showed that PCI was non-inferior to CABG surgery, the NOBLE trial suggested that CABG surgery is a better option. In the following review, we will discuss some of the similarities and contrasts between these two trials and conclude with lessons to be learned to our daily practice.
左主干冠状动脉（LMCA）疾病与发病率和死亡率的增加相关。冠状动脉旁路移植术（CABG）一直是这类患者的标准血运重建策略。然而，在过去十年中，随着支架设计和药物治疗的最新进展，已经设计了几项试验来评估经皮冠状动脉介入治疗（PCI）作为LMCA疾病患者CABG手术替代方案的安全性和有效性。最近，两项主要试验EXCEL和NOBLE在这一患者群体中比较CABG与PCI的结果已经公布。事实上，乍一看，两项试验的结果可能相互矛盾。虽然EXCEL试验表明PCI不劣于CABG手术，但NOBLE试验表明CABG手术是更好的选择。在以下综述中，我们将讨论这两项试验之间的一些异同，并总结从我们的日常实践中吸取的经验教训。
