Coronary artery bypass surgery of left main CAD to improve survival

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Saphenous Vein Graft Disease
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Intervention in left main coronary artery disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Coronary artery bypass surgery is more effective for treating left main disease than percutaneous coronary intervention.[1]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[2]

Left Main CAD Revascularization to Improve Survival (DO NOT EDIT)[2]

Class I
"1. CABG to improve survival is recommended for patients with significant (≥50% diameter stenosis) left main coronary artery stenosis.[3][4][5][6][7][8][9] (Level of Evidence: B)"
Class III: HARM
"1. PCI to improve survival should not be performed in stable patients with significant (≥50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG.[10][11][12][3][4][5][6] (Level of Evidence: B)"
Class IIa
"1. PCI to improve survival is reasonable as an alternative to CABG in selected stable patients with significant (≥50% diameter stenosis) unprotected left main CAD with: 1) anatomic conditions associated with a low risk of PCI procedural complications and a high likelihood of good long-term outcome (eg, a low SYNTAX score [≤22], ostial or trunk left main CAD); and 2) clinical characteristics that predict a significantly increased risk of adverse surgical outcomes (eg, STS-predicted risk of operative mortality ≥5%).[10][11][12][13][14][15][16][17][18][19][20][21][22] (Level of Evidence: B)"
"2. PCI to improve survival is reasonable in patients with UA/NSTEMI when an unprotected left main coronary artery is the culprit lesion and the patient is not a candidate for CABG.[10][17][18][23][24][25][21][22][26][27] (Level of Evidence: B)"
"3. PCI to improve survival is reasonable in patients with acute STEMI when an unprotected left main coronary artery is the culprit lesion, distal coronary flow is less than Thrombolysis In Myocardial Infarction grade 3, and PCI can be performed more rapidly and safely than CABG.[28][29][30] (Level of Evidence: C)"
Class IIb
"1. PCI to improve survival may be reasonable as an alternative to CABG in selected stable patients with significant (≥50% diameter stenosis) unprotected left main CAD with: 1) anatomic conditions associated with a low to intermediate risk of PCI procedural complications and an intermediate to high likelihood of good long-term outcome (eg, low–intermediate SYNTAX score of <33, bifurcation left main CAD); and 2) clinical characteristics that predict an increased risk of adverse surgical outcomes (eg, moderate–severe chronic obstructive pulmonary disease, disability from previous stroke, or previous cardiac surgery; STS-predicted risk of operative mortality >2%).[10][11][12][13][31][15][16][17][18][19][20][21][22][32] (Level of Evidence: B)"

References

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  31. Capodanno D, Caggegi A, Miano M; et al. (2011). "Global Risk Classification and Clinical SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) Score in Patients Undergoing Percutaneous or Surgical Left Main Revascularization". Journal of the American College of Cardiology. 4: 287–297. doi:10.1016/j.jcin.2010.10.013. Retrieved 2011-12-13. line feed character in |author= at position 14 (help)
  32. Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Chung CH, Lee JW, Lim DS, Rha SW, Lee SG, Gwon HC, Kim HS, Chae IH, Jang Y, Jeong MH, Tahk SJ, Seung KB (2011). "Randomized trial of stents versus bypass surgery for left main coronary artery disease". The New England Journal of Medicine. 364 (18): 1718–27. doi:10.1056/NEJMoa1100452. PMID 21463149. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)

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