PCI Has More Benefits and Harms Than CABG for Selected Patients with Left Main Coronary Artery Disease


Am Fam Physician. 2017 Apr 1;95(7):455a-456.

Clinical Question

For selected patients with left main coronary artery disease, is percutaneous coronary intervention (PCI) with a drug-eluting stent an option to replace coronary artery bypass grafting (CABG)?

Bottom Line

The authors of this study—which was sponsored by a manufacturer of stents—argue that the results prove that PCI is just as good as CABG for many patients with a left main lesion. A deeper dive into the data suggests that it is not quite so clear. Patients undergoing PCI had fewer early myocardial infarctions, but more later deaths and later myocardial infarctions. There are other benefits to PCI, including shorter hospital stay, lower cost, and faster recovery. But patients should be informed of the tradeoffs, and it is important to look at longer-term outcomes beyond three years (which the investigators promise to do). (Level of Evidence = 1b)


Guidelines in Europe and the United States continue to recommend CABG as the preferred treatment for all patients with left main coronary artery disease. However,

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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May 1, 2017

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