Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial

Holm, Niels Ramsing; Mäkikallio, Timo H.; Lindsay, Mitchell; Spence, Mark S.; Ērglis, Andrejs; Menown, Ian; Trovik, Thor; Kellerth, Thomas; Kalinauskas, Gintaras; Mogensen, Lone Juul Hune; Nielsen, Per Hostrup; Niemelä, Matti; Lassen, Jens Flensted; Oldroyd, Keith G.; Berg, G; Stradiņš, Pēteris; Walsh, Simon; Graham, Alastair; Endresen, Petter Cappelen; Fröbert, Ole; Trivedi, Uday; Anttila, Vesa; Hildick‐Smith, David; Thuesen, Leif; Christiansen, Evald Høj; investigators, Noble study

doi:10.1016/s0140-6736(19)32972-1

Cited by 354 publications

(245 citation statements)

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“…In contrast to previous 3-year data, EXCEL did note an excess of all-cause mortality at 5 years with PCI which attracted comment in the general media. Conversely, the NOBLE (Nordic-Baltic-British left main revascularisation study) [8], which included all-comer left main complexity, reported a higher incidence of the composite of death, MI (excluding peri-procedural MI), repeat revascularisation, and stroke for PCI (28% vs. 19%; P = 0.0002) ( Fig. 2).…”

Section: Advances In Interventional Cardiologymentioning

confidence: 99%

Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials

et al. 2020

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Introduction: A large number of important clinical trials in cardiology were published or presented at major international conferences during 2019. This paper aims to offer a concise overview of these significant advances and to put them into clinical context. Methods: Trials presented at the major international cardiology meetings during 2019 were reviewed including The American College of Cardiology (ACC), Euro PCR, The European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), and the American Heart Association (AHA). In addition to this a literature search identified several other publications eligible for inclusion based on their relevance to clinical cardiology, their potential impact on clinical practice and on future guidelines. Results: A total of 70 trials met the inclusion criteria. New interventional and structural data include trials examining use of drug-coated balloons in patients with acute myocardial infarction (MI), interventions following Digital Features To view digital features for this article go to

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Section: Advances In Interventional Cardiologymentioning

confidence: 99%

Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials

et al. 2020

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“…In EXCEL [8], which studied low to intermediate left main complexity, the incidence of death, stroke, or MI (including periprocedural MI) was similar in the PCI and CABG cohorts (22.0% vs 19.2%; 95% CI, -0.9 to 6.5; P = 0.13). Conversely, in the NOBLE study [9], which studied all-comer left main complexity, the incidence of death, MI (excluding peri-procedural MI), repeat revascularisation, and stroke was higher for PCI (28% vs 19%; p = 0.0002). However, neither study showed an excess of CV death with PCI.…”

Section: Dear Readersmentioning

confidence: 90%

Cardiology and Therapy: A Summary of 2019 and Key Areas of Emerging Research in 2020

2020

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“…In late 2019, the five-year data for the EXCEL [114] and NOBLE [115] trials examining left main coronary stenosis of low and intermediate complexity were released. Great controversy surrounding the definition used for myocardial infarction (alleged to favour PCI) was ongoing at the time of this manuscript preparation.…”

Section: Final Word: Buying Into the Left Main Coronary Stenosis Pci mentioning

confidence: 99%

Why and how to achieve total arterial revascularisation in coronary surgery

Royse¹,

Royse²,

Boggett³

et al. 2020

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Single internal mammary artery and supplementary saphenous vein grafts (SVG) continues to be used in approximately 95% of coronary surgery as of 2019. The late failure of SVG is very well documented yet remains the predominant conduit used-why? The left internal mammary artery almost never fails, and late angiography of patent radial artery grafts also appear entirely normal. Logic would suggest that avoiding the conduit known to progressively fail would lead to improved late outcome. Our studies have demonstrated such findings in large single centre and national registry datasets. We describe strategies to achievement of total arterial coronary revascularisation.

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Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial

Cited by 354 publications

References 23 publications

Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials

Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials

Cardiology and Therapy: A Summary of 2019 and Key Areas of Emerging Research in 2020

Why and how to achieve total arterial revascularisation in coronary surgery

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