Percutaneous or surgical revascularization for left main stem disease: NOBLE ideas, but do they EXCEL?. (4th May 2019)

• Record Type: Journal Article
• Authors: Kassimis, George; Raina, Tushar; Kontogiannis, Nestoras; Krasopoulos, George; Gunn, Julian
• Is Part Of: Expert review of cardiovascular therapy. Volume 17:Number 5(2019)
• Page Start: 361
• Page End: 368
• Publication Date: 2019-05-04
• Subjects: Left main stem disease -- coronary artery bypass grafting -- percutaneous coronary intervention -- NOBLE -- EXCEL -- SYNTAX -- SYNTAXES -- MAIN COMPARE -- revascularization guidelines; Cardiovascular agents -- Research -- Periodicals; 616.12061
• DOI: 10.1080/14779072.2019.1615445
• Languages: English
• ISSNs: 1477-9072

Abstract

ABSTRACT: Introduction : Although coronary artery bypass grafting (CABG) has traditionally been the standard treatment for significant left main stem (LMS) disease, percutaneous coronary intervention (PCI) using drug-eluting stents (DES) is now considered an acceptable alternative. Areas covered : This article aims to summarise the key findings of the landmark clinical trials on LMS revascularization and the recently published ESC/EACTS guidelines on myocardial revascularization related to LMS disease. Expert opinion : It is unlikely that there will be a further large randomized trial aimed at addressing the issue of the optimum method of revascularization for LMS disease. Both PCI and CABG are reasonable revascularization options for appropriately selected patients with LMS disease. 'Heart Team' approach is vital to guide the management of patients with LMS disease, when there is obvious clinical equipoise and a mandate for complete revascularization. With an aging and increasing co-morbid patient population, clinical equipoise may not always be obvious, making extrapolation of clinical trial results to the 'real world' difficult.