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Stenting Left Main

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Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease Intravascular Ultrasound to Guide Left Main Stem Intervention: A Sub-Study of the NOBLE Trial Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location Left main coronary artery disease: importance, diagnosis, assessment, and management 10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting Comparative effectiveness analysis of percutaneous coronary intervention versus coronary artery bypass grafting in patients with chronic kidney disease and unprotected left main coronary artery disease Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Stenosis: A Meta-Analysis of Randomized Trials
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Review Article2018 Nov;33(6):660-664.

JOURNAL：Curr Opin Cardiol. Article Link

New-onset atrial fibrillation after PCI and CABG for left main disease: insights from the EXCEL trial and additional studies

Kosmidou I, Stone GW. Keywords: nonsurgical atrial fibrillation; LMCAD; CABG; PCI; outcome

ABSTRACT

PURPOSE OF REVIEW - To provide an up-to-date review of recent trials examining the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and the impact of postprocedural NOAF compared to nonsurgical atrial fibrillation.

 

RECENT FINDINGS - A recent analysis from the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that NOAF is much more frequent following surgical compared with percutaneous revascularization for LMCAD, and is strongly associated with an increased 3-year risk of mortality and stroke. In a recent Danish registry-based, propensity score-matched analysis, postsurgical NOAF conferred a lower risk of adverse outcomes compared with nonsurgical nonvalvular atrial fibrillation.

 

SUMMARY - These new studies confirm that although postsurgical NOAF after left main revascularization may be of less clinical significance than nonvalvular atrial fibrillation, its occurrence still is strongly associated with subsequent stroke and mortality. Future efforts are warranted to prevent postsurgical NOAF and determine strategies for its optimal management should it occur.


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