Percutaneous Treatment With Drug-Eluting Stent Implantation Versus Bypass Surgery for Unprotected Left Main Stenosis

Abstract

Background-Improvements

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

“…[10][11][12] Studies comparing PCI involving drugeluting stents with CABG have generally been smaller and nonrandomized. [13][14][15][16][17][18][19][20][21][22][23][24] Data from randomized, controlled trials of drug-eluting stents as compared with bare-metal stents have shown significant reductions in the rate of repeat intervention, with similar rates of death and myocardial infarction. 25 These improvements have led to expanded use of PCI in patients with complex coronary anatomical features, though most randomized trials comparing drugeluting stents and bare-metal stents excluded such patients.…”

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)

“…Bifurcation lesions are technically more chal-lenging 138 and have higher rates of restenosis. 140,141,143,144 In contrast, results of PCI of ostial or mid-body left main coronary lesions more closely approximate the results of CABG, even with respect to the need for subsequent procedures. 142 The best case for PCI as an alternative to CABG for left main CAD is in ostial and mid-body lesions without additional multivessel disease.…”

“…Moreover, because the overall study did not reach its primary end point, subset analyses are less robust; because noninferiority was not proven in this cohort, specific information for each subgroup is of an observational nature and is hypothesis-generating. 138,[140][141][142][143][144] and for patients with factors (such as severe lung disease, prior thoracic surgery, or poor bypass graft targets) that would make CABG a high-risk procedure or unlikely to be successful. Conversely, CABG surgery for unprotected left main CAD may be relatively more favorable for patients with left main CAD plus multivessel disease, 21 distal/bifurcation left main coronary artery lesions, 138,[140][141][142][143][144] or low surgical risk with a good chance of technical success.…”

Coronary Artery Bypass Grafting for Acute Myocardial Infarction in Stent ERA

“…A drug-eluting stent is now applied to an LMT lesion and demonstrates equivalent mortality and complications to CABG. 12,13) The number of stent implantations to an LMT lesion for AMI will increase when the risk of re-stenosis is eliminated and would reduce the mortality of emergent CABG, which was reported as 7.9%-14.2% and 9.8%-19.2% 2,6) in previous large studies. It is reported that a drug-eluting stent reduced the re-intervention rate compared to the bare-metal stent.…”