Modality selection for the revascularization of left main disease

Publication date: Available online 15 December 2018Source: Canadian Journal of CardiologyAuthor(s): Derrick Y. Tam, Faisal Bakaeen, Dmitriy N. Feldman, Philippe Kolh, Gaetano Antonio Lanza, Marc Ruel, Raffaele Piccolo, Stephen E. Fremes, Mario FL. GaudinoAbstractThe management of severe left main (LM) disease remains controversial and continues to evolve as new evidence emerges. Patient selection for CABG or PCI relies on both predicting mortality with CABG from clinical characteristics using the Society of Thoracic Surgeons risk score and anatomical complexity using the SYNTAX score. LM stenting techniques continue to evolve; for bifurcation lesions, the use of the double kiss crush technique may reduce the incidence of late target vessel revascularization. In patients with acute coronary syndrome (ACS) complicated by cardiogenic shock, PCI is likely the first-line option in those with anatomically amenable disease while all other stable non-ST elevated ACS should be treated similar to stable ischemic heart disease. Outcomes comparing CABG and PCI have been recently examined in two large randomized clinical trials. In general, early outcomes of periprocedural myocardial infarction and stroke favoured PCI or not different than with CABG. However, the conclusions of both trials are at present discordant with respect to late major adverse cardiac and cerebral events; additional follow-up of the trial patients is important for informed patient decision making. The appropriate mo...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research

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