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10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study) Restenosis, Stent Thrombosis, and Bleeding Complications - Navigating Between Scylla and Charybdis Coronary Artery Calcium Progression Is Associated With Coronary Plaque Volume Progression - Results From a Quantitative Semiautomated Coronary Artery Plaque Analysis Impact of Oxidative Stress on the Heart and Vasculature: Part 2 of a 3-Part Series Translational Perspective on Epigenetics in Cardiovascular Disease Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review Impact of Abnormal Coronary Reactivity on Long-Term Clinical Outcomes in Women New AHA/ACC/HRS Guidance on Sudden Cardiac Death Prevention Patient Characteristics Associated With Antianginal Medication Escalation and De-Escalation Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN CTO Registry Complete Revascularization During Primary Percutaneous Coronary Intervention Reduces Death and Myocardial Infarction in Patients With Multivessel Disease-Meta-Analysis and Meta-Regression of Randomized Trials
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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.
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