Revascularization for left main and multivessel coronary artery disease: Current status and future prospects after the EXCEL and NOBLE trials

Mohammed Al-Hijji, Abdallah El Sabbagh, David R. Holmes

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

Revascularization of severe lef main and multivessel coronary artery disease has been shown to improve survival in both stable ischemic heart disease and acute coronary syndrome. While revascularization with coronary artery bypass surgery for these disease entities carries class I recommendation in most current guidelines, recent trials has shown potential comparable survival and cardiovascular outcomes between percutaneous and surgical interventions in patients with less complex coronary anatomy. Despite the conflicting results observed in the most recent lef main revascularization trials, Everolimus-Eluting Stents or Bypass Surgery for Lef Main Coronary Artery Disease (EXCEL) and Nordic-Baltic-British lef main revascularization (NOBLE), both treatment strategies remain important for the management of lef main disease (LMD) and multivessel disease (MVD) reflecting on the importance of heart team discussion. This review is focused on revascularization of LMD and MVD in patients who are not presenting with ST-segment elevation myocardial infarction, encompassing the evidence from historic and contemporary trials which shaped up current practices. This review discusses the heart team approach to guide decision making, including special populations that are not represented in clinical trials.

Original languageEnglish (US)
Pages (from-to)447-462
Number of pages16
JournalKorean Circulation Journal
Volume48
Issue number6
DOIs
StatePublished - Jun 2018

Keywords

  • Coronary artery bypass
  • Coronary artery disease
  • Coronary disease
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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