Acute and Late Outcomes of Unprotected Left Main Stenting in Comparison With Surgical Revascularization

Abstract

Patients with ULMCA disease treated with PCI had favorable early outcomes in comparison with the CABG group. At 1 year, LVEF had improved significantly only in the PCI group. After more than 2 years, MACCE-free survival was similar in both groups with a trend toward improved survival after PCI.

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

“…[147][148][149] Several studies comparing CABG to PCI, however, indicated that the advantage of CABG consists primarily of fewer repeat revascularizations. 139,[149][150][151][152][153][154][155] The study by Brener et al 156 indicates no significant mortality difference between PCI and CABG after 3 years of follow-up. Longer-term follow-up is needed.…”

87 Coronary Revascularization in Lung Transplant Recipients with Concomitant Coronary Artery Disease

“…Despite equivalent survival, this more tenuous postoperative course is concerning, and therefore in accordance with these results, our current practice is to preferentially perform preoperative PCI with bare metal stents if technically feasible (exceptions may include left main disease and inability to tolerate antiplatelet therapy). The current guidelines by American College of Cardiology Foundation and the American Heart Association provide a Class 1 recommendation for CABG to improve survival in patients with significance stenosis of the left main coronary artery; however, they do note that PCI may be a reasonable alternative in selected patients (28 (29). In a randomized trial comparing CABG versus PCI for 1800 patients (SYNTAX trial NCT00114972), a prespecified subgroup analysis of 705 patients with left main disease demonstrated comparable safety and efficacy at 1 year; however, the authors noted the need for longer follow-up to confirm these findings (30).…”

Intravascular ultrasound-guided percutaneous coronary intervention in left main coronary bifurcation lesions: a review

“…Study 5 was conducted to determine the safety and efficacy of PCI compared to CABG in LM patients. A total of 105 patients who present with >50% LM coronary artery (LMCA) narrowing, with or without multivessel CAD, were randomized to either PCI (n=52) or CABG (n=53) to compare the early and late results of PCI and surgical revascularization of LMCA.…”

“…56 The optimal MSA cutoff that best predicted angiographic in-stent restenosis (ISR) after SES implantation on a segmental basis was 5 Figure 4.…”