TY - JOUR
T1 - Revascularization for left main and multivessel coronary artery disease
T2 - Current status and future prospects after the EXCEL and NOBLE trials
AU - Al-Hijji, Mohammed
AU - Sabbagh, Abdallah El
AU - Holmes, David R.
N1 - Publisher Copyright:
© 2018 The Korean Society of Cardiology.
PY - 2018/6
Y1 - 2018/6
N2 - 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.
AB - 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.
KW - Coronary artery bypass
KW - Coronary artery disease
KW - Coronary disease
KW - Percutaneous coronary intervention
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U2 - 10.4070/kcj.2018.0078
DO - 10.4070/kcj.2018.0078
M3 - Review article
AN - SCOPUS:85048132736
SN - 1738-5520
VL - 48
SP - 447
EP - 462
JO - Korean Circulation Journal
JF - Korean Circulation Journal
IS - 6
ER -