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 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