Coronary revascularization for patients with unprotected left main coronary artery disease: Evidence, guidelines, and judgment! making clinical decisions in 2009

Issam D. Moussa, S. Chiu Wong, Ted Feldman

Research output: Contribution to journalReview articlepeer-review

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 languageEnglish (US)
Pages (from-to)448-458
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Volume74
Issue number3
DOIs
StatePublished - Sep 1 2009
Externally publishedYes

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

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