Problem 3VD and/or LMS
Format Multi-center RCT
Treatment CABG or PCI
Control Nil
Population 1800 patients
Inclusion criteria Inclusion criteria included de novo (previously untreated) lesions, ≥50% target vessel stenosis with stable/unstable angina or atypical chest pain. If asymptomatic, positive evidence of myocardial ischemia was required.
Exclusion criteria Key exclusion criteria included previous PCI or CABG, acute myocardial infarction (MI), or the need for concomitant cardiac surgery.
Follow-up 12 months
Primary endpoint Composite of death from any cause, stroke, myocardial infarction, or repeat vascularization by 12 months.
Secondary endpoint(s) Primary endpoints, independently
Details For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry.
Brief summary: In LMS/3VD PCI (1st gen DES) by 1 year had higher revasc. and CV death
PAPER: Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
Date 5 Mar 2009
Journal N Engl J Med. 2009 Mar 5;360(10):961-72.
Information Non inferiority trial for PCI (vs CABG) for 3VD and/or LMS disease
All lesions deemed amenable to either therapy

MACE or stroke @ 12 months significantly higher for PCI (RR 1.44; p=0.002)
-Largely due to increased rate of repeat revascularization (RR 2.29; p<0.001)
Death from cardiac causes higher for PCI (RR 1.75; p=0.05)
Reduced rate of stroke for PCI (RR 0.25; p=0.003)
Similar rates of death and MI

Imp: CABG to remain standard