Purpose of Review While left main coronary artery (LMCA) disease is often evaluated based on angiographic findings, technical limitations of angiography or the presence of intermediate disease can make accurate lesion assessment difficult. Recent Findings The rise of intravascular imaging and functional assessment of coronary artery disease lesions over the past 20 years has greatly improved PCI outcomes, making it an acceptal alternative to CABG in selected patients and lesions (Class IIa recommendation, after multidisciplinary Heart-Team discussion). We reviewed the advances of intravascular imaging (IVUS and OCT) and functional assessment (FFR and iFR) over the last 5-10 years specifically as it pertains to left main coronary artery disease. Functional assessment of the left main coronary artery and its bifurcations can help decide which lesion needs intervention. Summary Intravascular imaging prior to and after PCI of lesions involving the left main and its bifurcations leads to decreased frequency of PCI complications, and more importantly, better long-term outcomes for the patient owing to a decreased frequency of target-vessel and target-lesion revascularization.
Keywords Left main • PCI • IVUS • FFR • Coronary artery disease • Intravascular imaging • Intermediate lesion assessmentThis article is part of the Topical Collection on Intravascular Imaging
Introduction Lung cancer remains the leading cause of cancer-related death in the United States. Low density CT (LDCT) has been shown to reduce mortality in high-risk populations. Recognizing and mitigating gaps in knowledge in early medical training could result in increased utilization of screening CT in high risk-populations. Methods An electronic survey was conducted among Internal Medicine (IM) residents at 4 academic programs in the Midwestern United States. A survey was distributed to evaluate knowledge about high-risk populations, mortality benefits, and a comparison in mortality benefits between LDCT and other screening modalities using number needed to screen (NNS). Results: There was a 46.6% (166/360) response rate. Residents correctly answered an average of 2.9/7 (43.1%) questions. PGY-1 (post-graduate year) and PGY-2 residents performed better than PGY-3 (P = .022). Only 1/3 rd of all respondents correctly identified the population needed to be screened. Over 80% of residents thought screening with LDCT had a cancer-specific mortality benefit but were evenly split (except Program 2 residents), on recognizing an all-cause mortality benefit with LDCT, (P = .016). Only 7.7% thought women benefited the most from LDCT. Self-assess and attained knowledge were similar among programs. Conclusions LDCT is a noninvasive intervention with a substantial mortality reduction, especially in states with high rates of smoking, and is widely covered by insurers. With average knowledge score less than 50%, this study shows there is a substantial need to increase the knowledge of LCS in IM residency programs.
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