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Balloon Aortic Valvuloplasty as a Bridge to Aortic Valve Replacement: A Contemporary Nationwide Perspective Transcatheter Aortic Valve Replacement: Role of Multimodality Imaging in Common and Complex Clinical Scenarios 中国肺动脉高压诊断与治疗指南(2021版) Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey Short Length of Stay After Elective Transfemoral Transcatheter Aortic Valve Replacement Is Not Associated With Increased Early or Late Readmission Risk Change in Kidney Function and 2-Year Mortality After Transcatheter Aortic Valve Replacement von Willebrand Factor and Management of Heart Valve Disease: JACC Review Topic of the Week Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality Association of Sustained Blood Pressure Control with Multimorbidity Progression Among Older Adults 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial

EditorialSeptember 2017, [Online First]

JOURNAL:JAMA Cardiol. Article Link

Left Main Revascularization in 2017 Coronary Artery Bypass Grafting or Percutaneous Coronary Intervention?

Ajay J. Kirtane, Robert O. Bonow Keywords: Revascularization; CABG; PCI

ABSTRACT

It can be argued that severe left main coronary artery (LMCA) disease represents the only anatomic subtype of coronary artery disease for which there is clear and unequivocal prognostic evidence in favor of coronary revascularization across the spectrum of clinical presentation—from stable ischemic heart disease to acute coronary syndrome. For decades, the standard approach to LMCA revascularization has been through coronary artery bypass grafting (CABG) given its ability to safely and effectively achieve complete revascularization. More recently, revascularization through percutaneous coronary intervention (PCI) has been proposed as an alternative to CABG for traditionally surgical anatomy. Predicate data from the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) clinical trial and other clinical trials have suggested that the LMCA may be ideally suited to maximize the potential relative benefits of PCI (less invasiveness, ideally suited for larger vessels with more focal disease) while mitigating its relative disadvantages (restenosis and stent thrombosis, especially when tackling diffuse disease). However, until recently, the prospective evidence base on which this assertion was based was limited.