In this clinical practice guideline, the recommendations and levels of evidence are classified in accordance with the updated JCS statement, encompassing the estimated benefit in proportion to risk (Tables 1,2).

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Background:The optimal revascularization strategy for unprotected left main coronary artery (ULMCA) disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Methods and Results:Since April 2004, 89 patients underwent CABG, including 82 (92.1%) off-pump procedures and 63 patients underwent PCI with DES for ULMCA disease. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularization) and hospitalization costs were compared. Patients in the CABG group were likely to have multivessel disease and higher euroSCORE. The mean follow-up was 2.2±1.1 years in the CABG group and 1.6±0.8 years in the DES group (P<0.001). The overall survival rate did not differ (P=0.288) between the groups (CABG: 93.4% and DES: 91.9% at 2 years). The MACCE-free survival rate was better (P=0.033) in the CABG group (CABG: 82.2% and DES: 62.6% at 2 years). Total hospitalization costs were lower (P=0.013) in the CABG group (median: 3,225 thousand yen) than in the DES group (median: 4,192 thousand yen).Conclusions: CABG might be associated with cost-effectiveness and could be still the first revascularization strategy for ULMCA disease. (Circ J 2010; 74: 449 - 455)

BiVAD biventricular assist device BTB bridge to bridge BTC bridge to candidacy BTD bridge to decision BTR bridge to recovery BTT bridge to transplantation CHD Congenital heart disease CRT cardiac resynchronization therapy DT destination therapy ECMO extracorporeal membrane oxygenation EUROMACS European Registry for Patients with Mechanical Circulatory Support HM-II HeartMate II IABP intra-aortic balloon pump ICD implantable cardioverter defibrillator

Approximately 25% of patients with diabetic retinopathy receiving ophthalmologic care as outpatients have a significant stenotic coronary artery disease. Of the total diabetic population, a large number of patients with diabetic retinopathy who show strong indications for early coronary artery bypass grafting might well go unrecognized.