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NOBLE Five Year Follow Up


European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain


NOBLE Five Year Follow Up

Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark


  • 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

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