Why is this study important?

The optimal treatment method, percutaneous coronary intervention (PCI) versus coronary artery bypass graft surgery, to obtain long-term success for obstructive left main disease remains controversial. 
 
The risks and benefits associated with PCI with drug-eluting stents and coronary bypass graft surgery have been studied in multiple clinical trials, with variable durations of follow-up.
 
This study examined the 10-year mortality outcomes from the randomized Nordic-Baltic-British left main revascularization (NOBLE) trial, with a strategy of percutaneous coronary angioplasty with drug-eluting stents versus coronary artery bypass graft surgery in the treatment of unprotected left main stenosis.
 

What question was this study supposed to answer?

The NOBLE trial was designed to compare a current strategy of percutaneous coronary intervention utilizing drug-eluting stents versus coronary artery bypass graft surgery in patients with unprotected left main coronary artery disease.
 
Meta-analyses of multiple clinical trials comparing percutaneous coronary intervention with drug-eluting stents versus coronary bypass graft surgery for left main coronary disease suggest no separation of mortality curves through 1 year. However, from years 1 through 5, the curves appeared to be separating, with the not-statistically significant benefit favoring coronary artery bypass graft surgery.
 
This trial included data from a single clinical trial with 10-year long-term mortality follow-up.
 

What did the study show?

The NOBLE trial revealed similar all-cause 10-year mortality for the treatment of unprotected left main stenosis with either a strategy of percutaneous coronary intervention with drug-eluting stent or coronary artery bypass graft surgery.
 
In patients presenting with an acute coronary syndrome, percutaneous coronary intervention with drug-eluting stents was associated with lower mortality than coronary artery bypass graft surgery. 
 
The Syntax score had no association with a difference in mortality between percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass graft surgery.