6/28/23, 11:22 PM NOBLE Pathway Feedback Search Clinical Topics Home Studies NOBLE NOBLE Disease Coronary artery disease Trial question What is the role of PCI in patients with left main coronary artery disease? Study design Multi-center Open label RCT Population Characteristics of study participants 21.4% female N = 1201 78.6% male 1201 patients (256 female, 928 male) Inclusion criteria: patients with stable angina, unstable angina, or non-ST elevation myocardial infarction and left main coronary artery disease Key exclusion criteria: STEMI within 24 h, too high risk for CABG or PCI, or expected survival of < 1 year Interventions N=598 PCI (PCI with drug-eluting stents) N=603 CABG (CABG according to present clinical practice) Primary outcome Rate of Kaplan-Meier 5 year estimates of major adverse cardiac or cerebrovascular events https://web.pathway.md/studies/recf3dXyXUkIUDi1j 1/2 6/28/23, 11:22 PM NOBLE Pathway 29.0 % 29 21.8 % 19 14.5 % Difference exceeding nonferiority margin 7.3 % 0.0 % PCI CABG Difference exceeding nonferiority margin in the rate of Kaplan-Meier 5 year estimates of major adverse cardiac or cerebrovascular events (29% vs. 19%; HR 1.48, 95% CI 1.11 to 1.96) Secondary outcomes No significant difference in death from any cause (12% vs. 9%; HR 1.07, 95% CI 0.67 to 1.72) Conclusion In patients with stable angina, unstable angina, or non-ST elevation myocardial infarction and left main coronary artery disease, PCI was not noninferior to CABG with respect to the rate of Kaplan- Meier 5 year estimates of major adverse cardiac or cerebrovascular events. Reference Makikallio T, Holm NR, Lindsay M et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016 Dec 3;388(10061):2743-2752. Open reference URL https://web.pathway.md/studies/recf3dXyXUkIUDi1j 2/2