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[Comment] Randomised trials in left main disease: a NOBLE effort

Although patients with less extensive coronary artery disease are routinely treated with percutaneous coronary intervention (PCI) and those with more extensive multivessel disease, especially diabetes, are treated with coronary artery bypass grafting (CABG), the optimum treatment of patients with left main disease has been the subject of numerous randomised trials. A prespecified and sufficiently powered subanalysis of patients with left main disease in the SYNTAX trial1 was hypothesis generating in that there was a signal that some patients with left main stenosis, namely less complex disease as defined by the lower two tertiles of the SYNTAX score, could just as effectively be treated with PCI as with CABG.