Abstract
The current clinical practice guidelines categorize the use of coronary artery bypass graft (CABG) surgery for revascularization of patients with unprotected left main coronary artery disease (ULMCAD) as a class IA recommendation while it categorize the use of percutaneous coronary interventions (PCI) as a class III recommendation. The evidence underlying these recommendations is weak and out dated. The purpose of this review is to critically reevaluate current state-of-the-art with respect to revascularization of patients with ULMCAD who are acceptable surgical candidates. In doing so we will highlight the divergence between practice guidelines and patient-centered clinical decision-making; critically appraise the "evidence" underlying the current practice guidelines; review the emerging data regarding utility of CABG versus PCI in these patients; and finally discuss the elements of a contemporary approach to clinical decision-making in light of the current state of knowledge.
Original language | English (US) |
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Pages (from-to) | 448-458 |
Number of pages | 11 |
Journal | Catheterization and Cardiovascular Interventions |
Volume | 74 |
Issue number | 3 |
DOIs | |
State | Published - Sep 1 2009 |
Externally published | Yes |
Keywords
- Bypass grafts coronary
- GRFT
- Left main coronary disease
- LMCD
- PCI
- Percutaneous coronary intervention
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine