Long-term outcomes after percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting for left main coronary artery disease: a prospective analysis of the multicentre IRIS-MAIN registry
Main finding · All-cause mortalityResult — go to the resultOverlap-weighted hazard ratio 1.00 95% CI 0.87–1.14Authors' conclusion
In this non-randomised registry analysis of patients with left main coronary artery disease, there was no statistically detectable difference in all-cause mortality between PCI and CABG. For patients considered suitable for either strategy, multidisciplinary Heart Team discussion might help patients and clinicians weigh potential trade-offs in the choice between PCI and CABG. These findings are observational and cannot establish causal treatment effects or equivalence in survival.
Study context
- Population
- Adults aged 18 years or older with unprotected left main coronary artery disease (defined as a stenosis diameter of ≥50% as visually estimated on angiography)included in the analysis, 6900 patients were enrolled in the IRIS-MAIN registry, of whom 5379 (78.0%) underwent coronary revascularisation · percutaneous coronary intervention (PCI) with drug-eluting stents 3,836 [71.3%] · coronary artery bypass grafting (CABG) 1,543 [28.7%]
- Participants
- 5,379 adults
- Exposure
- PCI with drug-eluting stents vs isolated CABG
- PCIn = 3,836
- CABGn = 1,543
- Outcome
- All-cause mortality
- Follow-up
- 10-year weighted Kaplan-Meier rates
Methodological detailstarget trial emulation framework, propensity-score overlap weighting, non-randomised, 46 hospitals in South Korea, India, Japan, Indonesia, and Malaysia
- Target trial emulation framework
- Propensity-score overlap weighting
- Non-randomised
- 46 hospitals in South Korea, India, Japan, Indonesia, and Malaysia
Main finding
As reported in the abstract
Overlap-weighted hazard ratio
1.00
95% CI 0.87–1.14
P = 0.99
By group
PCIvs CABG
overlap-weighted hazard ratio 1.00 (95% CI 0.87–1.14); P = 0.99
Observational data: associations, not effects.
Further findings
- The median duration of follow-up for all patients was 10.0 years (IQR 5.0-16.7).
Original publication
Long-term outcomes after percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting for left main coronary artery disease: a prospective analysis of the multicentre IRIS-MAIN registry. Lancet. Published 3 November 2026. doi:10.
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