***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The purpose of this r and omized study was to compare sirolimus-eluting stenting with coronary artery bypass grafting ( CABG ) for patients with unprotected left main ( ULM ) coronary artery disease . BACKGROUND CABG is considered the st and ard of care for treatment of ULM . Improvements in percutaneous coronary intervention ( PCI ) with use of drug-eluting stents might lead to similar results . The effectiveness of drug-eluting stenting versus surgery has not been established in a r and omized trial . METHODS In this prospect i ve , multicenter , r and omized trial , 201 patients with ULM disease were r and omly assigned to undergo sirolimus-eluting stenting ( n = 100 ) or CABG using predominantly arterial grafts ( n = 101 ) . The primary clinical end point was noninferiority in freedom from major adverse cardiac events , such as cardiac death , myocardial infa rct ion , and the need for target vessel revascularization within 12 months . RESULTS The combined primary end point was reached in 13.9 % of patients after surgery , as opposed to 19.0 % after PCI ( p = 0.19 for noninferiority ) . The combined rates for death and myocardial infa rct ion were comparable ( surgery , 7.9 % vs. stenting , 5.0 % ; noninferiority p < 0.001 ) , but stenting was inferior to surgery for repeat revascularization ( 5.9 % vs. 14.0 % ; noninferiority p = 0.35 ) . Perioperative complications including 2 strokes were higher after surgery ( 4 % vs. 30 % ; p < 0.001 ) . Freedom from angina was similar between groups ( p = 0.33 ) . CONCLUSIONS In patients with ULM stenosis , PCI with sirolimus-eluting stents did not show noninferiority [ corrected ] to CABG at 12-month follow-up with respect to freedom from major adverse cardiac events , which is mainly influenced by repeated revascularization , whereas for hard endpoints , [ corrected ] PCI results are favorable . A longer follow-up is warranted . [ corrected Background — The prospect i ve , multinational , r and omized Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery ( SYNTAX ) trial was design ed to assess the optimal revascularization strategy between percutaneous coronary intervention ( PCI ) and coronary artery bypass grafting ( CABG ) , for patients with left main ( LM ) and /or 3-vessel coronary disease . Methods and Results — This observational hypothesis-generating analysis reports the results of a prespecified powered subgroup of 705 r and omized patients who had LM disease among the 1800 patients with de novo 3-vessel disease and /or LM disease r and omized to PCI with paclitaxel-eluting stents or CABG in the SYNTAX trial .  Major adverse cardiac and cerebrovascular event rates at 1 year in LM patients were similar for CABG and PCI ( 13.7 % versus 15.8 % ; & Dgr;2.1 % [ 95 % confidence interval −3.2 % to 7.4 % ] ; P=0.44 ) . At 1 year , stroke was significantly higher in the CABG arm ( 2.7 % versus 0.3 % ; & Dgr;−2.4 % [ 95 % confidence interval −4.2 % to −0.1 % ] ; P=0.009 ] ) , whereas repeat revascularization was significantly higher in the PCI arm ( 6.5 % versus 11.8 % ; & Dgr;5.3 % [ 95 % confidence interval 1.0 % to 9.6 % ] ; P=0.02 ) ; there was no observed difference between groups for other end points . When patients were scored for anatomic complexity , those with higher baseline SYNTAX scores had significantly worse outcomes with PCI than did patients with low or intermediate SYNTAX scores ; outcomes for patients with CABG did not correlate with baseline SYNTAX score , but baseline EuroSCORE significantly predicted outcomes for both treatments . Conclusions — Patients with LM disease who had revascularization with PCI  had safety and efficacy outcomes comparable to CABG at 1 year ; longer follow-up is required to determine whether these 2 revascularization strategies offer comparable medium-term outcomes in this group of complex patients . Clinical Trial Registration — http://www . clinical trials.gov . Unique identifier : NCT00114972 BACKGROUND Percutaneous coronary intervention ( PCI ) is increasingly used to treat unprotected left main coronary artery stenosis , although coronary-artery bypass grafting ( CABG ) has been considered to be the treatment of choice . METHODS We r and omly assigned patients with unprotected left main coronary artery stenosis to undergo CABG ( 300 patients ) or PCI with sirolimus-eluting stents ( 300 patients ) . Using a wide margin for noninferiority , we compared the groups with respect to the primary composite end point of major adverse cardiac or cerebrovascular events ( death from any cause , myocardial infa rct ion , stroke , or ischemia-driven target-vessel revascularization ) at 1 year . Event rates at 2 years were also compared between the two groups . RESULTS The primary end point occurred in 26 patients assigned to PCI as compared with 20 patients assigned to CABG ( cumulative event rate , 8.7 % vs. 6.7 % ; absolute risk difference , 2.0 percentage points ; 95 % confidence interval [ CI ] , -1.6 to 5.6 ; P=0.01 for noninferiority ) . By 2 years , the primary end point had occurred in 36 patients in the PCI group as compared with 24 in the CABG group ( cumulative event rate , 12.2 % vs. 8.1 % ; hazard ratio with PCI , 1.50 ; 95 % CI , 0.90 to 2.52 ; P=0.12 ) . The composite rate of death , myocardial infa rct ion , or stroke at 2 years occurred in 13 and 14 patients in the two groups , respectively ( cumulative event rate , 4.4 % and 4.7 % , respectively ; hazard ratio , 0.92 ; 95 % CI , 0.43 to 1.96 ; P=0.83 ) . Ischemia-driven target-vessel revascularization occurred in 26 patients in the PCI group as compared with 12 patients in the CABG group ( cumulative event rate , 9.0 % vs. 4.2 % ; hazard ratio , 2.18 ; 95 % CI , 1.10 to 4.32 ; P=0.02 ) . CONCLUSIONS In this r and omized trial involving patients with unprotected left main coronary artery stenosis , PCI with sirolimus-eluting stents was shown to be noninferior to CABG with respect to major adverse cardiac or cerebrovascular events . However , the noninferiority margin was wide , and the results can not be considered clinical ly directive . ( Funded by the Cardiovascular Research Foundation , Seoul , Korea , and others ; PRECOMBAT Clinical Trials.gov number , NCT00422968 . ) Background — Current guidelines recommend coronary artery bypass graft surgery ( CABG ) when treating significant de novo left main coronary artery ( LM ) stenosis ; however , percutaneous coronary intervention ( PCI ) has a class IIa indication for unprotected LM disease in selected patients . This analysis compares 5-year clinical outcomes in  PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery ( SYNTAX ) trial , the largest trial in this group to date . Methods and Results — The SYNTAX trial r and omly assigned 1800 patients with LM or 3-vessel disease to receive either PCI ( with TAXUS Express paclitaxel-eluting stents ) or CABG .  The unprotected LM cohort ( N=705 ) was predefined and powered . Major adverse cardiac and cerebrovascular event rates at 5 years was 36.9 % in PCI patients and 31.0 % in CABG patients ( hazard ratio , 1.23 [ 95 % confidence interval , 0.95–1.59 ] ; P=0.12 ) . Mortality rate was 12.8 % and 14.6 % in PCI and CABG patients , respectively ( hazard ratio , 0.88 [ 95 % confidence interval , 0.58–1.32 ] ; P=0.53 ) . Stroke was significantly increased in the CABG group ( PCI 1.5 % versus CABG 4.3 % ; hazard ratio , 0.33 [ 95 % confidence interval , 0.12–0.92 ] ; P=0.03 ) and repeat revascularization in the PCI arm ( 26.7 % versus 15.5 % ; hazard ratio , 1.82 [ 95 % confidence interval , 1.28–2.57 ] ; P<0.01 ) . Major adverse cardiac and cerebrovascular events were similar between arms in patients with low/intermediate SYNTAX scores but significantly increased in PCI patients with high scores ( ≥33 ) . Conclusions — At 5 years , no difference in overall major adverse cardiac and cerebrovascular events was found between treatment groups . PCI-treated patients had a lower stroke but a higher revascularization rate versus CABG . These results suggest that both treatments are valid options for LM patients . The extent of disease should accounted for when choosing between surgery and PCI , because patients with high SYNTAX scores seem to benefit more from surgery compared with those in the lower tertiles . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00114972 Background — The objective of the present study was to compare the midterm follow-up results of percutaneous coronary intervention ( PCI ) and coronary bypass graft surgery ( CABG ) for the treatment of unprotected left main coronary artery disease in octogenarians . Methods and Results — A total of 249 consecutive patients ≥80 years of age diagnosed with left main coronary artery disease underwent coronary revascularization in our center between January 2002 and January 2008 ; 145 patients underwent CABG , and 104 patients had PCI .  Major adverse cardiac and cerebrovascular events ( MACCE [ cardiac death , myocardial infa rct ion , cerebrovascular event , revascularization ] ) were evaluated at a mean follow-up of 23±16 months . Patients who underwent PCI were older ; had higher creatinine levels , lower ejection fraction , and higher EuroSCORE ; and presented more frequently with an acute coronary syndrome . Drug-eluting stents were used in 48 % of PCI patients . A propensity score analysis was performed to adjust for baseline differences between the 2 groups . Survival free of cardiac death or myocardial infa rct ion  ( PCI , 65.4 % ; CABG , 69.7 % ) and MACCE-free survival  ( PCI , 56.7 % ; CABG , 64.8 % ) at follow-up were similar between the groups ( adjusted hazard ratio for survival free of cardiac death or myocardial infa rct ion , 1.28 ; 95 % CI , 0.64 to 2.56 ; P=0.47 ; adjusted hazard ratio for MACCE-free survival , 1.11 ; 95 % CI , 0.59 to 2.0 ; P=0.73 ) . The EuroSCORE value was an independent predictor of MACCE regardless of the type of revascularization ( hazard ratio , 1.17 for each EuroSCORE increase of 1 point ; 95 % CI , 1.09 to 1.25 ; P<0.0001 ) . Conclusions — In this single-center , nonr and omized study , there were no significant differences in cardiac death or myocardial infa rct ion and MACCE  between CABG and PCI for the treatment of left main coronary artery disease in octogenarians after a mean follow-up of 2 years . Baseline EuroSCORE was the most important predictor of MACCE regardless of the type of revascularization . R and omized studies comparing both revascularization strategies in this high-risk coronary population are warranted BACKGROUND Currently available r and omized data on the comparison between percutaneous coronary intervention ( PCI ) and coronary artery bypass graft ( CABG ) for the treatment of unprotected left main coronary disease ( LMD ) lacks statistical power due to low numbers of patients enrolled . OBJECTIVES This study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity . METHODS We conducted a pooled analysis of individual patient-level data of the LMD patients included in the PRECOMBAT ( Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease ) and SYNTAX ( Synergy Between PCI With TAXUS and Cardiac Surgery ) trials . Incidences of major adverse cardiac events were assessed at 5 years follow-up . RESULTS Study population comprised 1,305 patients . The incidence of major adverse cardiac and cerebrovas 
    Output:
    
Stratified analysis based on stent types showed that the increased risk for myocardial infa rct ion associated with PCI was only evident in patients with bare-metal stents or early-generation drug-eluting stents ( DES ) , but not newer-generation DES .
Conclusions Compared with CABG , PCI with newer-generation DES might be a safe alternative revascularization strategy for treatment of left main CAD , but is associated with more repeat revascularization