Percutaneous Coronary Intervention vs. Coronary Artery Bypass Graft Surgery for Unprotected Left Main Coronary Artery Disease in the Drug-Eluting Stents Era

Alam, Mahboob; Huang, Henry; Shahzad, Saima A.; Kar, Biswajit; Virani, Salim S.; Rogers, Paul A.; Paniagua, David; Bozkurt, Biykem; Palacios, Igor F.; Kleiman, Neal S.; Jneid, Hani

doi:10.1253/circj.cj-12-0747

Cited by 36 publications

(26 citation statements)

References 45 publications

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“…There was no difference in stroke rate at 5 years or at ≥3 years. This finding is in contrast with other studies . This could be due to the acute occurrence of majority of strokes (within a month of index procedure) in the CABG arm [12/26 (46%) in EXCEL, 2/2 (100%) in Buszman et al .…”

Section: Discussioncontrasting

confidence: 71%

“…This finding is in contrast with other studies. 3,35 This could be due to the acute occurrence of majority of strokes (within a month of index procedure) in the CABG arm [12/26 (46%) in EXCEL, 19 2/2 (100%) in Buszman et al 21 In the subgroup analysis, PCI was, however, equally safe as CABG for MACCE in patients with a low-to-intermediate SYNTAX score…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta‐analysis of randomized controlled trials

Sharma

Dahal

Khatra

et al. 2017

Cardiovascular Therapeutics

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta‐analysis of randomized controlled trials

Sharma

Dahal

Khatra

et al. 2017

Cardiovascular Therapeutics

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“…25) In addition, our results demonstrated the rate of stroke was significantly higher regardless of the diabetes, confirmed by several meta-analyses with large sample numbers comparing PCI and CABG for ULMCA patients. 26,27) Farooq, et al developed SYNTAX score II which contains 8 predictors, including the presence of ULMCA disease, and could well predict 4-year mortality in patients with complex coronary artery disease. 8) Diabetes was excluded from the SYN-TAX score II since diabetes was not an independent predictor of mortality in patients with complex coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

Influence of Diabetes Mellitus on Long-Term Outcomes of Patients With Unprotected Left Main Coronary Artery Disease Treated With Either Drug-Eluting Stents or Coronary Artery Bypass Grafting

Luo

et al. 2015

Int. Heart J.

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SummaryWhether the effect of diabetes on patients with unprotected left main coronary artery (ULMCA) disease differs according to different strategies of revascularization was unknown. This study was conducted to evaluate the impact of diabetes on patients with ULMCA disease treated with either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG).A total of 922 patients with ULMCA disease who received drug-eluting stent (DES) (n = 465) implantation or underwent CABG (n = 457) were retrospectively analyzed. We compared the effects of these 2 treatments on clinical outcomes (death, myocardial infarction, stroke, repeat revascularization, and the composite of death, myocardial infarction, or stroke), according to diabetic status.During the median follow-up of 7.1 years (interquartile range, 5.3 to 8.2 years), no difference was found between PCI and CABG in the adjusted occurrence of death (P = 0.112) and the composite endpoints of death, myocardial infarction, and stroke (P = 0.235). Significantly higher incidence of repeat revascularization (P < 0.001) was observed in the DES group, whereas the CABG group had a significantly higher rate of stroke (P = 0.001). These trends were consistent in both diabetic and nondiabetic patients. We did not observe significant interactions between treatment outcomes and the presence or absence of diabetes after adjustment for covariates (P interaction = 0.580 for the composite of death, MI and stroke, P interaction = 0.685 for death, P interaction = 0.416 for MI, P interaction = 0.470 for stroke, and P interaction = 0.502 for repeat revascularization).Presence of diabetes was not important for decision-making between CABG and PCI in patients with ULMCA disease. (Int Heart J 2015; 56: 43-48)

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“…Reported treatment options include bypass surgery, percutaneous coronary intervention (PCI), anticoagulation heparin or glycoprotein IIbIIIa inhibitors and thrombolysis. Current evidence suggests that PCI could be as good as coronary artery bypass graft in the management of LMCA occlusion 13. In our patient, the distal LAD artery occlusion was successfully managed with balloon angioplasty and stenting.…”

Section: Discussionmentioning

confidence: 67%

A case of left main coronary artery embolus further embolising to the left anterior descending artery

2014

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SUMMARYCoronary embolism is an uncommon cause of myocardial infarction. The usual source of a coronary embolus is an intracardiac thrombus or vegetation. Embolisation to the left main coronary artery is an extremely rare event and is usually fatal. We present a case of a 38-year-old woman with embolisation to the left main coronary artery which further embolised distally to the left anterior descending artery leading to a non-ST elevation myocardial infarction. The non-occlusive nature of the left main coronary artery embolus might have led to a favourable prognosis in our patient. BACKGROUND

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Percutaneous Coronary Intervention vs. Coronary Artery Bypass Graft Surgery for Unprotected Left Main Coronary Artery Disease in the Drug-Eluting Stents Era

Cited by 36 publications

References 45 publications

Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta‐analysis of randomized controlled trials

Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta‐analysis of randomized controlled trials

Influence of Diabetes Mellitus on Long-Term Outcomes of Patients With Unprotected Left Main Coronary Artery Disease Treated With Either Drug-Eluting Stents or Coronary Artery Bypass Grafting

A case of left main coronary artery embolus further embolising to the left anterior descending artery

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