EBC - ON DEMAND
European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain
LM SESSION
NOBLE Five Year Follow Up
Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark
BACKGROUND
- Initial NOBLE report (LANCET 2016) indicated that PCI was inferior to CABG for MACCE
- Mortality was similar
- No difference in stroke
- Higher rates of spontaneous MI and revascularization after PCI
CONCLUSIONS – NOBLE Five Year Follow Up
- The NOBLE trial is conclusive: PCI was inferior to CABG in treatment of LMCA stenosis at 5 years for the primary endpoint of MACCE
- Mortality was similar for PCI and CABG
- Difference in MACCE driven by higher rates of non-procedural myocardial infarctions and repeat revascularization after PCI
- SYNTAX score <23 did not identify a subgroup with more balanced outcome
- CABG had longer index admissions, more reOP, more blood transfusions Heart Team conference AND thorough balanced discussion with the patient