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New-onset atrial fibrillation after PCI and CABG for left main disease: insights from the EXCEL trial and additional studies Percutaneous Coronary Intervention of Left Main Disease: Pre- and Post-EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) Era Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease Stress Echocardiography and PH: What Do the Findings Mean? A risk score to predict postdischarge bleeding among acute coronary syndrome patients undergoing percutaneous coronary intervention: BRIC-ACS study Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions Long-term health outcome and mortality evaluation after invasive coronary treatment using drug eluting stents with or without the IVUS guidance. Randomized control trial. HOME DES IVUS Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease Extracellular Myocardial Volume in Patients With Aortic Stenosis
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Review Article2018 Nov;33(6):660-664.

JOURNAL：Curr Opin Cardiol. Article Link

New-onset atrial fibrillation after PCI and CABG for left main disease: insights from the EXCEL trial and additional studies

Kosmidou I, Stone GW. Keywords: nonsurgical atrial fibrillation; LMCAD; CABG; PCI; outcome

ABSTRACT

PURPOSE OF REVIEW - To provide an up-to-date review of recent trials examining the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and the impact of postprocedural NOAF compared to nonsurgical atrial fibrillation.


RECENT FINDINGS - A recent analysis from the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that NOAF is much more frequent following surgical compared with percutaneous revascularization for LMCAD, and is strongly associated with an increased 3-year risk of mortality and stroke. In a recent Danish registry-based, propensity score-matched analysis, postsurgical NOAF conferred a lower risk of adverse outcomes compared with nonsurgical nonvalvular atrial fibrillation.


SUMMARY - These new studies confirm that although postsurgical NOAF after left main revascularization may be of less clinical significance than nonvalvular atrial fibrillation, its occurrence still is strongly associated with subsequent stroke and mortality. Future efforts are warranted to prevent postsurgical NOAF and determine strategies for its optimal management should it occur.


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