Long-term outcomes associated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease remain an area of ongoing debate. A real-world registry analysis presented at the AATS 2026 compared long-term outcomes associated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using mandatory statewide clinical registries from New Jersey.

The retrospective cohort study included adults with left main coronary artery disease (≥50% stenosis) who underwent PCI with stenting or isolated CABG between January 2007 and December 2018. Registry data were linked with mortality and administrative databases to enable longitudinal follow-up. Propensity score matching using 24 baseline characteristics yielded 700 matched patient pairs for comparative analyses.

Findings

• During the study period, 950 patients underwent PCI and 11,214 underwent CABG.
• The proportion of patients treated with PCI increased from 4.8% in 2007 to 13.5% in 2018 (p<0.001).
• At 10 years, PCI was associated with higher mortality than CABG: 59.1% vs 48.3% (HR 1.68 [95% CI 1.44-1.96]).
• Myocardial infarction and repeat revascularization occurred more frequently after PCI than CABG: 18.6% vs 8.4% (HR 2.60 [95% CI 1.86-3.65]) and 19.8% vs 8.7% (HR 2.26 [95% CI 1.62-3.15]), respectively.
• Major adverse cardiac and cerebrovascular events (MACCE) were more common after PCI than CABG: 71.1% vs 58.9% (HR 1.78 [95% CI 1.54-2.05]).
• Stroke rates did not differ significantly between PCI and CABG: 6.1% vs 9.4% (HR 0.77 [95% CI 0.50–1.18]).
• Increased MACCE risk with PCI remained consistent when the composite endpoint included only mortality, myocardial infarction, and stroke: 67.2% vs 55.9% (HR 1.78 [95% CI 1.54-2.06]).

In this real-world registry analysis of left main coronary artery disease, CABG was associated with lower long-term risks of mortality, myocardial infarction, repeat revascularization, and MACCE compared with PCI over 10 years of follow-up.