Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis.

Abstract:

PURPOSE OF REVIEW:This article reviews the latest data on unprotected left main (ULM) percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery, with a focus on the NOBLE and EXCEL trials. RECENT FINDINGS:In EXCEL trial, the primary endpoint at 3 years was 15.4% in the PCI group and 14.7% in the CABG group (p = 0.02 for non-inferiority of PCI versus CABG). In NOBLE, the primary endpoint at 5 years was 28% and 18% for PCI and CABG, respectively (HR 1.51, CI 1.13-2.0, which did not meet the criteria for non-inferiority of PCI to CABG; p for superiority of CABG was 0.0044). Higher repeat revascularization and non-procedural myocardial infarction were noted in PCI group but there was no difference in all-cause or cardiac mortality between the two groups. A heart team approach with appropriate patient selection, careful assessment of LM lesions, and meticulous procedural technique makes PCI a valid alternative to CABG for ULM stenosis.

journal_name

Curr Cardiol Rep

authors

Taha Y,Patel RAG,Bagai J,Sachdeva R,Kumar G,Prasad A,Nathan S,Paul TK

doi

10.1007/s11886-019-1113-0

subject

Has Abstract

pub_date

2019-03-18 00:00:00

pages

27

issue

5

eissn

1523-3782

issn

1534-3170

pii

10.1007/s11886-019-1113-0

journal_volume

21

pub_type

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