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 this prospective, multicentre registry study of 5,379 Asian patients with unprotected left main coronary artery disease, the authors asked whether long-term all-cause mortality differs between PCI with drug-eluting stents and isolated CABG. Using target trial emulation and overlap weighting, they found no statistically detectable difference at 10 years (24.0% for PCI vs 22.9% for CABG; HR 1.00, 95% CI 0.87-1.14). Because the study is non-randomised, the authors caution that it cannot establish causal equivalence, though it supports Heart Team discussion when either strategy is reasonable.