Is percutaneous coronary intervention as effective as bypass surgery in left main stem coronary artery stenosis?
- PDF / 435,361 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 2 Downloads / 232 Views
viation list BMS CABG CI DES FFR IVUS MACCE MACE MI PCI RCT ST TVR VD
bare-metal stent coronary artery bypass graft confidence interval drug-eluting stent fractional flow reserve intravascular ultrasound major adverse cardiac and cardiovascular events major adverse cardiac events myocardial infarction percutaneous coronary intervention randomized controlled trial stent thrombosis target vessel revascularization vessel disease
Left main coronary artery disease is a major challenge for interventional cardiologists owing to the possible fatal complications. Coronary artery bypass graft (CABG) surgery is commonly accepted as the standard of care for patients with unprotected left main stenosis, with less than 5% of patients in the United States undergoing percutaneous coronary intervention (PCI) [1]. However, recent advances have spread optimism that PCI offers a proper alternative to cardiac surgery. This article reviews the most important trial results and the implementations in current guidelines in order to guarantee the best management of patients with left main stenosis.
T. Stiermaier · G. Schuler · E. Boudriot · S. Desch · H. Thiele Department of Internal Medicine - Cardiology, University of Leipzig - Heart Center, Leipzig
Is percutaneous coronary intervention as effective as bypass surgery in left main stem coronary artery stenosis?
Natural history
Surgical revascularization
A significant left main stenosis is diagnosed in approximately 4% of patients undergoing coronary angiography, mostly in combination with multivessel disease [2]. One of the first descriptions of a larger patient cohort originates from the 1970s [3]. Conley et al. reported 3-year survival rates of 66% and 41% in patients with a 50–70% and >70% left main stenosis, respectively. The majority of these patients (82%) had concomitant three-vessel coronary artery disease. Patients with three-vessel disease and a left main stenosis of >70% had significantly lower survival rates when compared to patients with three-vessel disease and normal left main coronary artery. The poor prognosis of left main coronary artery disease is generally accepted, although it is impossible to quantify its true impact on disease progression since it rarely occurs isolated.
In the late 1970s, several trials reported a survival benefit of CABG over medical therapy in patients with left main stenosis. The Veterans Administration Cooperative Study randomly assigned 91 patients to surgery or medical therapy and showed a significantly better survival with CABG after 42 months [4]. The Coronary Artery Surgery Study (CASS) registry contains 1,484 patients with left main stenosis >50%. Median survival was 13.3 years in the surgery group versus 6.6 years in the medical group. However, CABG did not improve survival in the subgroup of patients with normal left ventricular systolic function [5]. A meta-analysis of seven randomized controlled trials (RCTs) dem-
The first two authors should both be considered as first author.
Tab. 1 Main clinical results of randomized contro
Data Loading...
