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A problem-solving strategy is a plan of action used to find a solution. Different strategies have distinct action plans. Trial and error involves trying different solutions until one works. For instance, to fix a broken printer, you might check ink levels, ensure the paper tray isn't jammed, and verify the printer's connection to your laptop. This method can be time-consuming but is commonly used. Thomas Edison, for example, used trial and error to find a suitable filament for the light...
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Left Coronary Artery Ligation: A Surgical Murine Model of Myocardial Infarction
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Spontaneous Myocardial Infarction After Left Main Revascularization: The EXCEL Trial.

Mahesh V Madhavan1,2, John Gregson3, Bjorn Redfors2,4,5

  • 1New York-Presbyterian Hospital and the Columbia University Irving Medical Center, New York, NY (M.V.M.).

Circulation
|February 10, 2026
PubMed
Summary

Spontaneous myocardial infarction (MI) occurred more often after percutaneous coronary intervention (PCI) than coronary artery bypass graft (CABG) surgery for left main coronary artery disease. This MI independently predicted higher mortality risk following either procedure.

Keywords:
coronary artery bypassleft main coronary artery diseasemyocardial infarctionpercutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Limited data exist on spontaneous myocardial infarction (MI) rates and outcomes after left main coronary artery disease (LMCAD) revascularization.
  • Comparing spontaneous MI after percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) is crucial for understanding long-term prognosis.

Purpose of the Study:

  • To compare the rates of spontaneous MI after PCI versus CABG for LMCAD.
  • To evaluate the prognostic implications of spontaneous MI on cardiovascular and all-cause mortality within 5 years post-revascularization.

Main Methods:

  • Analysis of spontaneous and procedural MI from the EXCEL trial (N=1882) for patients with LMCAD.
  • Cox proportional hazards regression used to assess the association between MI and 5-year mortality outcomes.

Main Results:

  • Spontaneous MI occurred in 6.8% after PCI versus 3.4% after CABG (adjHR, 2.01; P=0.002).
  • Spontaneous MI independently predicted increased cardiovascular (adjHR, 9.39) and all-cause mortality (adjHR, 4.77) at 5 years.
  • Procedural MI was also associated with increased mortality, but less strongly than spontaneous MI.

Conclusions:

  • Spontaneous MI is more frequent after PCI than CABG for LMCAD revascularization.
  • Spontaneous MI significantly increases long-term mortality risk, irrespective of the revascularization strategy.
  • Spontaneous MI carries a higher mortality risk than large procedural MI.