• Yasir Taha, Patel Rajan A G RAG Ochsner Medical Center, New Orleans, LA, USA., Jayant Bagai, Rajesh Sachdeva, Gautam Kumar, Anand Prasad, Sandeep Nathan, and Timir K Paul.
• Morehouse School of Medicine, Atlanta, GA, USA.
• Curr Cardiol Rep. 2019 Mar 18; 21 (5): 27.

Purpose Of ReviewThis article reviews the latest data on unprotected left main (ULM) percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery, with a focus on the NOBLE and EXCEL trials.Recent FindingsIn EXCEL trial, the primary endpoint at 3 years was 15.4% in the PCI group and 14.7% in the CABG group (p = 0.02 for non-inferiority of PCI versus CABG). In NOBLE, the primary endpoint at 5 years was 28% and 18% for PCI and CABG, respectively (HR 1.51, CI 1.13-2.0, which did not meet the criteria for non-inferiority of PCI to CABG; p for superiority of CABG was 0.0044). Higher repeat revascularization and non-procedural myocardial infarction were noted in PCI group but there was no difference in all-cause or cardiac mortality between the two groups. A heart team approach with appropriate patient selection, careful assessment of LM lesions, and meticulous procedural technique makes PCI a valid alternative to CABG for ULM stenosis.

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