scholarly journals Triaging patients with left main disease after the EXCEL and NOBLE trials: the everlasting saga of coronary artery bypass grafting and percutaneous coronary intervention

2017 ◽  
Vol 9 (9) ◽  
pp. 2766-2770
Author(s):  
Davide Capodanno
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Left Main Disease ◽  
Percutaneous Coronary

scholarly journals The EXCEL Trial: The Surgeons’ Perspective

2020 ◽  
Vol 15 ◽  
Author(s):  
Marjan Jahangiri ◽  
Krishna Mani ◽  
Martin T Yates ◽  
Justin Nowell
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Left Main Stem Disease

There have been several investigations comparing the efficacy of percutaneous coronary intervention and coronary artery bypass grafting surgery for treatment of left main stem disease. This includes the Evaluation of XIENCE versus Coronary Artery Bypass Graft Surgery for Effectiveness of Left Main Revascularizaton (EXCEL) trial, which has garnered significant controversy surrounding its experimental design and reporting of its results. The authors review the methodology, results, caveats and statements on the EXCEL trial. They also review the other trials in the management of left main stem disease comparing percutaneous coronary intervention with coronary artery bypass grafting, as well as the SYNTAX score and its role in future guidelines for revascularisation. These findings have significant implications for current practice, influencing the growing role for multidisciplinary team meeting and allowing clinicians and patients to make the right choice.

Left Main Coronary Artery Disease in Diabetics: Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting?

2021 ◽  
Author(s):  
Logan Disney ◽  
Chandrashekhar Ramaiah ◽  
Meghna Ramaiah ◽  
Suresh Keshavamurthy
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Artery Bypass Grafting ◽  
Percutaneous Coronary

AbstractThe choice between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for myocardial revascularization in patients with left main disease (LMD) is controversial. There is general agreement that CABG is appropriate for all patients, and PCI is acceptable for those with low-to-intermediate anatomic complexity. However, there is uncertainty about the relative safety and efficacy of PCI in patients with more complex LMD and with comorbidities such as diabetes. No direct comparison trial has focused on revascularization in diabetic patients with LMD, and thus conclusions on the topic are subject to the limitations of subgroup analysis, as well as the heterogeneous exclusion criteria, and methodologies of individual trials. The available evidence suggests that among diabetics, CABG is superior in patients with LMD with SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and dardiac surgery) score greater than 33, distal bifurcation disease, or multivessel disease. PCI may be appropriate in those with less-extensive disease or those with limited life expectancy or high surgical risk.

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