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Stenting Left Main

Abstract

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Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study Complex PCI procedures: challenges for the interventional cardiologist Differential prognostic impact of treatment strategy among patients with left main versus non-left main bifurcation lesions undergoing percutaneous coronary intervention: results from the COBIS (Coronary Bifurcation Stenting) Registry II Long-Term Outcomes of Different Two-Stent Techniques With Second-Generation Drug-Eluting Stents for Unprotected Left Main Bifurcation Disease: Insights From the FAILS-2 Study Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study Long-term outcomes following mini-crush versus culotte stenting for the treatment of unprotected left main disease: insights from the Milan and New-Tokyo (MITO) registry Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention
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Editorial2019 Oct 12;394(10206):1299-1300.

JOURNAL：Lancet. Article Link

Expansion or contraction of stenting in coronary artery disease?

Taggart DP, Pagano D. Keywords: PCI vs CABG; left main

ABSTRACT

In the past four decades, more than 20 trials of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have tested whether iterative technical advances in PCI have made it as effective as CABG in patients with stable coronary artery disease. The clinical relevance of most of these trials to real-world practice has, however, been plagued by three issues.


First, by largely enrolling highly selected patients with low-severity coronary artery disease, the trials were inherently biased towards more favourable outcomes for PCI. Second, by limiting follow-up to a few years, the trials hid the accelerating divergence in survival benefit of CABG. Third, even in relatively contemporary trials, surgical patients received substantially inferior medical therapy, thereby mitigating the overall benefits of CABG. 
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