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1Cardiovascular and Thoracic Surgeon, Institute for Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospitals), Chennai, 600026 India.
Indian Journal of Thoracic and Cardiovascular Surgery
|October 16, 2020
Summary
Percutaneous coronary interventions (PCI) are not yet proven superior to coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). An objective heart-team approach is needed for optimal patient care.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left main coronary artery disease (LMCAD) poses significant prognostic risk due to the large myocardial territory involved.
- Coronary artery bypass grafting (CABG) has historically been the gold standard treatment for LMCAD.
Purpose of the Study:
- To evaluate the current evidence comparing percutaneous coronary interventions (PCI) and CABG for LMCAD.
- To discuss the role and implementation of the heart-team approach in managing LMCAD.
Main Methods:
- Review of recent major clinical trials (e.g., NOBEL, EXCEL) comparing PCI and CABG for LMCAD.
- Discussion on the practical application and effectiveness of the heart-team approach in real-world settings.
Main Results:
- Contradictory results from recent trials suggest PCI is not definitively superior to CABG for LMCAD.
- The extent and manner of heart-team approach implementation in clinical practice remain unclear.
Conclusions:
- The superiority of PCI over CABG for LMCAD remains unproven.
- There is a need for a more objective and standardized heart-team approach in managing LMCAD patients.
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