Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 68, Issue 11, Pages 1233-1246Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2016.05.089
Keywords
clinical decision making; coronary artery bypass; coronary disease; percutaneous coronary intervention; revascularization; stents
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Funding
- CardioVascular Research Foundation, Seoul, Korea [2015-09]
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Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease, and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and serious composite outcomes, a higher rate of stroke with CABG, and a higher rate of repeat revascularization with PCI. These results have been translated to the current guideline recommendation that PCI is a reasonable alternative to CABG in patients with low to intermediate anatomic complexity. However, how the characteristics, treatment, and clinical outcomes of patients with unprotected LMCA disease have evolved over time has not yet been fully evaluated. We therefore described secular trends in the characteristics and long-term outcomes of unprotected LMCA disease using real-world clinical experience from the IRIS-MAIN (Interventional Research Incorporation Society-Left MAIN Revascularization) registry together with a broad review of this topic. (C) 2016 by the American College of Cardiology Foundation.
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