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
In brief
PCI and bypass show similar 10-year mortality in an Asian registry
Among 5,379 Asian patients treated for left main coronary disease, weighted 10-year mortality was 24.0% after stenting and 22.9% after bypass, with no statistically detectable difference. Because this was an observational registry, it cannot prove the procedures are equivalent or establish which is better for an individual patient; the findings support discussing trade-offs when both options are suitable.
- Journal
- Lancet (London, England) (Q1)
- Published
- 3 November 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Seong-Bong Wee, Do-Yoon Kang, Jung-Min Ahn, Ju Hyeon Kim, Min-Ju Kim, Seung-Woon Rha, et al.
- PMID
- 42976899
- DOI
- 10.1016/S0140-6736(26)02104-5
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 5 November 2026): Long-term PCI versus CABG outcomes in left main disease
Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) with drug-eluting stents has been widely used to treat patients with left main coronary artery disease; however, long-term comparative outcomes versus coronary artery bypass grafting (CABG) in real-world populations remain poorly characterised. We aimed to compare long-term all-cause mortality after PCI or CABG in Asian patients with unprotected left main coronary artery disease. METHODS: We analysed prospectively collected data from the multicentre IRIS-MAIN registry, conducted at 46 hospitals in South Korea, India, Japan, Indonesia, and Malaysia. The registry enrolled 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), who had been treated with PCI, CABG, or medical therapy alone. The primary outcome was all-cause mortality. We used a target trial emulation framework to compare the long-term risk of all-cause mortality between PCI with drug-eluting stents and isolated CABG. We used propensity-score overlap weighting to adjust for measured baseline covariates. The IRIS-MAIN Registry study is registered with ClinicalTrials.gov (NCT01341327). FINDINGS: Between Jan 1, 2003, and Dec 31, 2024, 6900 patients were enrolled in the IRIS-MAIN registry, of whom 5379 (78·0%) underwent coronary revascularisation through either PCI with drug-eluting stents (3836 [71·3%]) or CABG (1543 [28·7%]) and were included in the analysis. The median duration of follow-up for all patients was 10·0 years (IQR 5·0-16·7). In the overlap-weighted population, no statistically detectable difference in 10-year weighted Kaplan-Meier rates of all-cause mortality was observed between PCI and CABG (24·0% vs 22·9%; overlap-weighted hazard ratio 1·00 [95% CI 0·87-1·14]; p=0·99). The confidence interval does not exclude a mortality benefit or harm with either strategy. INTERPRETATION: 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. FUNDING: The CardioVascular Research Foundation (South Korea).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.