Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis

Giacoppo, Daniele; Colleran, Róisín; Cassese, Salvatore; Frangieh, Antonio H.; Wiebe, Jens; Joner, Michael; Schunkert, Heribert; Kastrati, Adnan; Byrne, Robert A.

doi:10.1001/jamacardio.2017.2895

Cited by 111 publications

(64 citation statements)

References 44 publications

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“…148 A significant interaction with time is notable, providing early benefit for PCI in terms of MI and periinterventional stroke, which is subsequently offset by a higher risk of spontaneous MI during long-term follow-up. The need for repeat revascularization is higher with PCI than with CABG.…”

Section: Left Main Coronary Artery Diseasementioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

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5,252

2,078

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Section: Left Main Coronary Artery Diseasementioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

Self Cite

5,252

2,078

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“…In a meta-analysis of the 4 largest studies of LMCA revascularization with follow-up available at 3 to 5 years, incorporating data from the EXCEL and NOBLE trials, the hazard ratio (HR) for death, stroke, or MI with PCI compared with CABG was neutral (1.06) in a random-effects model (P = 0.60). 22 Based on individual patient data reconstruction, the Kaplan-Meier estimates of death, stroke, or MI at 5 years were 18.3% for PCI and 16.8% for CABG (P = 0.52). No statistically significant subgroup interaction for this combined outcome was noted across studies based on the generation of DES used for PCI (P for interaction = 0.25).…”

Section: Meta-analyses Of Percutaneous Coronary Intervention Vs Coromentioning

confidence: 96%

Management of left main disease: an update

Fajadet

Capodanno

Stone

2018

European Heart Journal

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A severe narrowing of the left main coronary artery (LMCA), usually due to atherosclerosis, jeopardizes a large area of myocardium and increases the risk of major adverse cardiac events. Management strategies for LMCA disease include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). In general, PCI offers more rapid recovery and a lower early adverse event rate, whereas CABG offers a more durable procedure. The largest of six LMCA trials comparing PCI with CABG recently reported that in patients with site-reported low or intermediate anatomical complexity PCI was non-inferior to CABG with respect to the composite of death, stroke, or myocardial infarction at 3 years. This result was obtained on a background of contemporary PCI standards, including safer and more effective stents, intravascular imaging and physiology assessment. This review updates on the current management of LMCA disease, with an emphasis on clinical data and procedural knowledge supporting the use of PCI in a growing proportion of patients.

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“…In patients undergoing revascularization of LMCA stenosis, the PCI and CABG techniques are associated with a comparable risk. Although surgical intervention in the LMCA occlusion is an important treatment modality, it has been shown that there is no significant difference in the long-term outcomes between the two techniques provided the patient and procedure selection is appropriate (3,4). Additionally, in the SYNTAX trial subgroup analysis for LMCA revascularization, there was no significant difference between the PCI and CABG groups for a year (5).…”

Section: Discussionmentioning

confidence: 99%