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Left main coronary artery stenosis: state-of-the-art.
Curr Probl Cardiol. 2007 Mar; 32(3):103-93.CP

Abstract

Patients with stenosis of the left main coronary artery present difficult challenges. The risks associated with this lesion have been known since the early days of angiography when patients were found to have increased mortality during follow-up. This information led to the general guidelines that surgical revascularization should be considered the treatment of choice in patients with significant left main coronary artery stenosis. Current advances in invasive cardiology have brought important information to the field. Intravascular ultrasound is now used routinely to evaluate angiographically indeterminate lesions with criteria now set forward as to what constitutes an indication for revascularization. Stents have even further dramatically changed the landscape. There are substantial issues, however, that need to addressed. These include the following: (1) the effect of specific lesion location on outcome - it is known that patients with distal bifurcation left main disease have worse outcome; (2) the potential for subacute thrombosis of the left main coronary artery; (3) the impact of left ventricular function and patient comorbidities irrespective of the degree and location of left main coronary artery stenosis; and (4) the risk-benefit ratio of stenting versus coronary artery bypass graft surgery. These issues are currently being addressed in two seminally important trials including the SYNTAX trial, which randomizes patients with left main and/or three-vessel disease to either coronary artery bypass graft surgery or a TAXUS drug-eluting stent. This trial is in the final stages of patient recruitment and will have important implications for the field. The other trial is the COMBAT trial, which is focused exclusively on left main coronary artery stenosis and randomizes patients with left main coronary artery disease either to a Sirolimus-eluting stent (Cypher, Johnson and Johnson Cordis, USA) or to coronary artery bypass graft surgery. The field of left main coronary artery disease continues to expand in terms of the evidence available for optimal patient evaluation and selection of treatment modalities.

Authors+Show Affiliations

Weill Cornell Medical School, Qatar.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17382834

Citation

El-Menyar, Ayman A., et al. "Left Main Coronary Artery Stenosis: State-of-the-art." Current Problems in Cardiology, vol. 32, no. 3, 2007, pp. 103-93.
El-Menyar AA, Al Suwaidi J, Holmes DR. Left main coronary artery stenosis: state-of-the-art. Curr Probl Cardiol. 2007;32(3):103-93.
El-Menyar, A. A., Al Suwaidi, J., & Holmes, D. R. (2007). Left main coronary artery stenosis: state-of-the-art. Current Problems in Cardiology, 32(3), 103-93.
El-Menyar AA, Al Suwaidi J, Holmes DR. Left Main Coronary Artery Stenosis: State-of-the-art. Curr Probl Cardiol. 2007;32(3):103-93. PubMed PMID: 17382834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left main coronary artery stenosis: state-of-the-art. AU - El-Menyar,Ayman A, AU - Al Suwaidi,Jassim, AU - Holmes,David R,Jr PY - 2007/3/27/pubmed PY - 2007/7/11/medline PY - 2007/3/27/entrez SP - 103 EP - 93 JF - Current problems in cardiology JO - Curr Probl Cardiol VL - 32 IS - 3 N2 - Patients with stenosis of the left main coronary artery present difficult challenges. The risks associated with this lesion have been known since the early days of angiography when patients were found to have increased mortality during follow-up. This information led to the general guidelines that surgical revascularization should be considered the treatment of choice in patients with significant left main coronary artery stenosis. Current advances in invasive cardiology have brought important information to the field. Intravascular ultrasound is now used routinely to evaluate angiographically indeterminate lesions with criteria now set forward as to what constitutes an indication for revascularization. Stents have even further dramatically changed the landscape. There are substantial issues, however, that need to addressed. These include the following: (1) the effect of specific lesion location on outcome - it is known that patients with distal bifurcation left main disease have worse outcome; (2) the potential for subacute thrombosis of the left main coronary artery; (3) the impact of left ventricular function and patient comorbidities irrespective of the degree and location of left main coronary artery stenosis; and (4) the risk-benefit ratio of stenting versus coronary artery bypass graft surgery. These issues are currently being addressed in two seminally important trials including the SYNTAX trial, which randomizes patients with left main and/or three-vessel disease to either coronary artery bypass graft surgery or a TAXUS drug-eluting stent. This trial is in the final stages of patient recruitment and will have important implications for the field. The other trial is the COMBAT trial, which is focused exclusively on left main coronary artery stenosis and randomizes patients with left main coronary artery disease either to a Sirolimus-eluting stent (Cypher, Johnson and Johnson Cordis, USA) or to coronary artery bypass graft surgery. The field of left main coronary artery disease continues to expand in terms of the evidence available for optimal patient evaluation and selection of treatment modalities. SN - 0146-2806 UR - https://www.unboundmedicine.com/medline/citation/17382834/Left_main_coronary_artery_stenosis:_state_of_the_art_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0146-2806(06)00172-1 DB - PRIME DP - Unbound Medicine ER -