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https://www.readbyqxmd.com/read/28797009/left-main-coronary-stenosis-surgery-still-reigns
#1
Marc Ruel, Hidetake Kawajiri, David Glineur, Juan Grau, Mario Gaudino, Subodh Verma
PURPOSE OF REVIEW: Coronary artery bypass grafting (CABG) has been regarded as the mainstream treatment for unprotected left main coronary artery (ULMCA) stenosis. However, the results of the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial, in which percutaneous coronary intervention (PCI) was deemed noninferior to CABG, have raised a question whether the guidelines should be changed. This article provides a critical appraisal of recent randomized control trials (RCTs) on ULMCA stenosis...
September 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28792156/successful-treatment-of-unprotected-left-main-coronary-bifurcation-lesion-using-minimum-contrast-volume-with-intravascular-ultrasound-guidance
#2
Oh Hyun Lee, Chul Min Ahn, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong Ki Hong
Contrast-induced nephropathy (CIN) is a serious complication in patients undergoing percutaneous coronary intervention (PCI), and is associated with higher morbidity and mortality. The limiting volume of contrast medium is safest and most reliable strategy for CIN prevention. Intravascular ultrasound (IVUS) serves as an attractive alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of contrast agents. Here, we reported a case of successfully treated unprotected left main bifurcation lesion with heavily calcified and diffuse lesion under the IVUS-guided PCI using low volumes of contrast dye of total 12 cc in an elderly patient...
September 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28763313/generalizability-of-excel-and-noble-results-to-a-large-registry-population-with-unprotected-left-main-coronary-artery-disease
#3
Pil Hyung Lee, Se Hun Kang, Seungbong Han, Jung-Min Ahn, Jae Seok Bae, Cheol Hyun Lee, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Duk-Woo Park, Seung-Jung Park
OBJECTIVE: The aim of this study was to determine how trial-based findings of EXCEL and NOBLE might be interpreted and generalizable in 'real-world' settings with comparison of data from the large-scaled, all-comer Interventional Research Incorporation Society-Left MAIN Revascularization (IRIS-MAIN) registry. PATIENTS AND METHODS: We compared baseline clinical and procedural characteristics and also determined how the relative treatment effect of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) was different in EXCEL and NOBLE, compared with those of the multicenter, IRIS-MAIN registry (n=2481)...
July 31, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28760214/clinical-outcomes-with-percutaneous-coronary-revascularization-vs-coronary-artery-bypass-grafting-surgery-in-patients-with-unprotected-left-main-coronary-artery-disease-a-meta-analysis-of-6-randomized-trials-and-4-686-patients
#4
REVIEW
Tullio Palmerini, Patrick Serruys, Arie Pieter Kappetein, Philippe Genereux, Diego Della Riva, Letizia Bacchi Reggiani, Evald Christiansen, Niels R Holm, Leif Thuesen, Timo Makikallio, Marie Claude Morice, Jung-Min Ahn, Seung-Jung Park, Holger Thiele, Enno Boudriot, Mario Sabatino, Mattia Romanello, Giuseppe Biondi-Zoccai, Raphael Cavalcante, Joseph F Sabik, Gregg W Stone
Some but not all randomized controlled trials (RCT) have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents may be an acceptable alternative to coronary artery bypass grafting (CABG) surgery for the treatment of unprotected left main coronary artery disease (ULMCAD). We therefore aimed to compare the risk of all-cause mortality between PCI and CABG in patients with ULMCAD in a pairwise meta-analysis of RCT. METHODS: Randomized controlled trials comparing PCI vs CABG for the treatment of ULMCAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings...
August 2017: American Heart Journal
https://www.readbyqxmd.com/read/28738482/-viewpoint-on-treatment-strategy-choice-for-patientswith-unprotected-left-main-coronary-artery-lesion
#5
Y L Han
No abstract text is available yet for this article.
July 24, 2017: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/28707446/percutaneous-coronary-intervention-after-a-surgeon-says-no-way
#6
EDITORIAL
Samuel M Butman
The rate of surgical turndowns (1.5-2.5%) in this report that went on to PCI is relatively consistent across centers. Unprotected left main intervention in patients turned down for surgery has high hospital mortality. With certain caveats, the HEART Team approach to these unique patients may be the answer.
July 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28707445/angiographic-and-clinical-outcome-after-crush-of-everolimus-eluting-stent-for-distal-unprotected-left-main-disease
#7
Angela Migliorini, Renato Valenti, Ruben Vergara, Maria Grazia De Gregorio, Eleonora Gabrielli, Elena De Vito, Maria Raffaella Aicale, Nazario Carrabba, David Antoniucci
Obiectives: Angiographic and clinical outcomes after crushing of everolimus-eluting stent (EES) for distal unprotected left main disease (ULMD). BACKGROUND: Few data exist about crushing of EES for distal ULMD. METHODS: From the Florence ULMD Percutaneous Coronary Interevention Registry consecutive patients with distal ULMD treated with EES were included in the analysis. Patients treated with provisional stenting were compared with patients treated with crush stenting...
July 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28701487/differential-event-rates-and-independent-predictors-of-long-term-major-cardiovascular-events-and-death-in-5795-patients-with-unprotected-left-main-coronary-artery-disease-treated-with-stents-bypass-surgery-or-medication-insights-from-a-large-international-multicenter
#8
Se Hun Kang, Jung-Min Ahn, Cheol Hyun Lee, Pil Hyung Lee, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Duk-Woo Park, Seung-Jung Park
BACKGROUND: Identifying predictive factors for major cardiovascular events and death in patients with unprotected left main coronary artery disease is of great clinical value for risk stratification and possible guidance for tailored preventive strategies. METHODS AND RESULTS: The Interventional Research Incorporation Society-Left MAIN Revascularization registry included 5795 patients with unprotected left main coronary artery disease (percutaneous coronary intervention, n=2850; coronary-artery bypass grafting, n=2337; medication alone, n=608)...
July 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28692459/comparative-determinants-of-5-year-cardiovascular-event-rates-in-patients-with-unprotected-left-main-coronary-artery-disease
#9
Cheol Hyun Lee, Jung-Min Ahn, Pil Hyung Lee, Minkyu Han, Se Hun Kang, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Duk-Woo Park, Seung-Jung Park
BACKGROUND: Diabetes mellitus (DM), low ejection fraction (EF), and the extent of coronary artery disease (CAD) have all been identified as predictors of cardiovascular events in multivessel disease, but their comparative contributions to future risk remain unclear in patients with unprotected left main coronary artery (ULMCA) disease. Through this study we aimed to categorize the risk for cardiovascular events in patients with ULMCA disease using simple clinical descriptors. PATIENTS AND METHODS: Our study included a total of 5975 patients with ULMCA disease from the Interventional Research Incorporation Society-Left MAIN Revascularization registry who were treated with percutaneous coronary intervention (n=2850), coronary artery bypass grafting (n=2337), or medical therapy alone (n=608)...
August 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28684430/percutaneous-coronary-intervention-has-similar-5-year-survival-rates-to-coronary-artery-bypass-grafting-surgery-for-patients-with-unprotected-left-main-artery-disease
#10
Carlos Collet, Patrick W Serruys
No abstract text is available yet for this article.
August 2017: Evidence-based Medicine
https://www.readbyqxmd.com/read/28663763/long-term-outcomes-of-pci-vs-cabg-for-ostial-midshaft-lesions-in-unprotected-left-main-coronary-artery
#11
Cheng-Long Guo, Xian-Peng Yu, Bang-Guo Yang, Meng-Meng Li, Ji-Qiang He, Quan Li, Cheng-Xiong Gu, Shu-Zheng Lyu, Jian-Zeng Dong
BACKGROUND: There are limited data on long-term (> 5 years) outcomes of drug-eluting stent (DES) implantation compared with coronary artery bypass grafting (CABG) for ostial/midshaft left main coronary artery (LMCA) lesions. METHODS: Of the 259 consecutive patients in Beijing Anzhen Hospital with ostial/midshaft LMCA lesions, 149 were treated with percutaneous coronary intervention (PCI) with DES and 110 were with CABG. The endpoints of the study were death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, and major adverse cardiac and cerebrovascular events (MACCE, the composite of cardiac death, MI, stroke or repeat revascularization)...
April 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/28658308/unprotected-left-main-revascularization-percutaneous-coronary-intervention-versus-coronary-artery-bypass-an-updated-systematic-review-and-meta-analysis-of-randomised-controlled-trials
#12
Luca Testa, Azeem Latib, Mario Bollati, Rocco Antonio Montone, Antonio Colombo, Filippo Crea, Francesco Bedogni
BACKGROUND: The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. AIM: The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. METHODS: Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR)...
2017: PloS One
https://www.readbyqxmd.com/read/28616307/pci-or-cabg-for-severe-unprotected-left-main-coronary-artery-disease-making-sense-of-the-noble-and-excel-trials
#13
EDITORIAL
Anthony A Holmes, Sripal Bangalore
No abstract text is available yet for this article.
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28571187/study-of-short-and-intermediate-term-clinical-outcomes-of-patients-with-protected-and-unprotected-lmca-stenting
#14
Pooja M Vyas, Jayesh S Prajapati, Sibasis S Sahoo, Iva Vipul Patel, Jagjeet K Deshmukh, Chirag Patel, Roopesh Singhal
INTRODUCTION: Significant unprotected Left Main Coronary Artery (LMCA) disease is detected in 5%-7% of cases undergoing Coronary Angiography (CAG). Present guidelines have revealed the significance of anatomical location in left main artery stenosis and syntax scores for determination of Major Adverse Cardiac Events (MACE). Debate still persists over the best treatment regarding outcomes of Coronary Artery Bypass Grafting (CABG) and LMCA stenting for patients with LMCA disease. AIM: Aim of the study was to evaluate short and intermediate term clinical outcomes of Percutaneous Coronary Intervention (PCI) in LMCA disease in respect to mortality, Cerebrovascular Accidents (CVA), reinfarction, stent restenosis and need for repeat target lesion revascularization...
April 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28539596/intravascular-ultrasound-guidance-improves-the-long-term-prognosis-in-patients-with-unprotected-left-main-coronary-artery-disease-undergoing-percutaneous-coronary-intervention
#15
Jian Tian, Changdong Guan, Wenyao Wang, Kuo Zhang, Jue Chen, Yongjian Wu, Hongbing Yan, Yanyan Zhao, Shubin Qiao, Yuejin Yang, Gary S Mintz, Bo Xu, Yida Tang
This study compared the long term outcomes in patients with unprotected left main coronary artery (LMCA) disease who underwent stenting under the guidance of intravascular ultrasound (IVUS) or conventional angiography at a large single center. The primary outcome was the composite of all-cause death and myocardial infarction (MI) at 3 years. Target vessel revascularization (TVR) at 3 years was one of the secondary outcomes. Between January 2004 and December 2011, a total of 1,899 patients who underwent IVUS-guided (n = 713, 37...
May 24, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28532780/meta-analysis-comparing-coronary-artery-bypass-grafting-to-drug-eluting-stents-and-to-medical-therapy-alone-for-left-main-coronary-artery-disease
#16
REVIEW
Rahman Shah, Mohamed S Morsy, Darryl S Weiman, George W Vetrovec
Historically, coronary artery bypass graft (CABG) surgery has been the standard revascularization method for unprotected left main coronary artery (LMCA) disease. Over the last decade, several randomized controlled trials (RCTs) have shown favorable results for percutaneous coronary intervention (PCI) with drug-eluting stent (DES) compared with CABG; however, no RCT has been conducted directly comparing DESs with medical therapy alone (MTA). Furthermore, the 2 most recently reported larger RCTs, using new-generation DESs reached somewhat conflicting conclusions comparing the 2 revascularization strategies...
July 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28495897/geographical-difference-of-the-interaction-of-sex-with-treatment-strategy-in-patients-with-multivessel-disease-and-left-main-disease-a-meta-analysis-from-syntax-synergy-between-pci-with-taxus-and-cardiac-surgery-precombat-bypass-surgery-versus-angioplasty-using
#17
Yohei Sotomi, Yoshinobu Onuma, Rafael Cavalcante, Jung-Min Ahn, Cheol Whan Lee, David van Klaveren, Robbert J de Winter, Joanna J Wykrzykowska, Vasim Farooq, Marie-Claude Morice, Ewout W Steyerberg, Seung-Jung Park, Patrick W Serruys
BACKGROUND: The impact of sex on clinical outcomes of percutaneous coronary intervention and coronary artery bypass graft for patients with multivessel coronary disease and unprotected left main disease could be dissimilar between Western and Asian populations. METHODS AND RESULTS: To assess clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft in women and men with multivessel coronary disease and unprotected left main disease, a pooled analysis (n=3280) was performed using the patient-level data from 3 large randomized trials: SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery), PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and BEST (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials...
May 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28487356/intravascular-ultrasound-guidance-is-associated-with-better-outcome-in-patients-undergoing-unprotected-left-main-coronary-artery-stenting-compared-with-angiography-guidance-alone
#18
Pontus Andell, Sofia Karlsson, Moman A Mohammad, Matthias Götberg, Stefan James, Jens Jensen, Ole Fröbert, Oskar Angerås, Johan Nilsson, Elmir Omerovic, Bo Lagerqvist, Jonas Persson, Sasha Koul, David Erlinge
BACKGROUND: Small observational studies have indicated better outcome with intravascular ultrasound (IVUS) guidance when performing unprotected left main coronary artery (LMCA) percutaneous coronary intervention (PCI), but the overall picture remains inconclusive and warrants further investigation. We studied the impact of IVUS guidance on outcome in patients undergoing unprotected LMCA PCI in a Swedish nationwide observational study. METHODS AND RESULTS: Patients who underwent unprotected LMCA PCI between 2005 and 2014 because of stable coronary artery disease or acute coronary syndrome were included from the nationwide SCAAR (Swedish Coronary Angiography and Angioplasty Registry)...
May 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28487035/radial-versus-femoral-access-for-the-treatment-of-left%C3%A2-main-lesion-in-the-era-of-second-generation-drug-eluting-stents
#19
MULTICENTER STUDY
Sebastiano Gili, Fabrizio D'Ascenzo, Roberto Di Summa, Federico Conrotto, Enrico Cerrato, Alaide Chieffo, Giacomo Boccuzzi, Antonio Montefusco, Fabrizio Ugo, Pierluigi Omedé, Hiroyoshi Kawamoto, Francesco Tomassini, Marco Pavani, Ferdinando Varbella, Roberto Garbo, Maurizio D'Amico, Giuseppe Biondi Zoccai, Claudio Moretti, Javier Escaned, Antonio Colombo, Fiorenzo Gaita
Transradial access (TRA) is often avoided in favor of the transfemoral access (TFA) during percutaneous coronary interventions of the unprotected left main coronary artery (ULM), due to technical and safety concerns. The aim of this study was to compare the performance of TRA and TFA in the treatment of ULM with second-generation drug-eluting stents. Consecutive patients who underwent percutaneous coronary intervention on ULM with second-generation drug-eluting stents were retrospectively enrolled in the multicenter Failure in Left Main Study With 2nd Generation Stents (FAILS 2) registry...
July 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28473107/current-interventions-for-the-left-main%C3%A2-bifurcation
#20
REVIEW
Tanveer Rab, Imad Sheiban, Yves Louvard, Fadi J Sawaya, Jun Jie Zhang, Shao Liang Chen
Contemporary clinical trials, registries, and meta-analyses, supported by recent results from the EXCEL (Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease) and NOBLE (Percutaneous Coronary Angioplasty Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trials, have established percutaneous coronary intervention of left main coronary stenosis as a safe alternative to coronary artery bypass grafting in patients with low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) scores...
May 8, 2017: JACC. Cardiovascular Interventions
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