Coronary Revascularization for Patients with Severe Coronary Artery Disease: An Overview of Current Evidence and Treatment Strategies
|
|
- Gertrude Atkinson
- 5 years ago
- Views:
Transcription
1 Review J Jpn Coron Assoc 2015; 21: Coronary Revascularization for Patients with Severe Coronary Artery Disease: An Overview of Current Evidence and Treatment Strategies Hiroki Shiomi, Takeshi Kimura The technical and device refinements in percutaneous coronary intervention (PCI) and coronary artery bypass grafting () has achieved the improvement of outcome in patients with coronary artery disease (CAD). Optimal revascularization methods (PCI or ) for severe CAD such as multivessel and/or left main CAD is still in debate in the current clinical practice. In this review, therefore, we discuss the current status of coronary revascularization and outcome in patients with severe CAD on the basis of the evidence of clinical trials in DES era. KEY WORDS: coronary revascularization, PCI, I. Introduction Coronary artery disease (CAD) is still one of the leading cause of death worldwide. Coronary revascularization as well as medical treatment is an established key treatment for both acute coronary syndrome and stable CAD over the past several decades. Coronary artery bypass grafting () was started in the 1960s and the introduction of internal thoracic artery (ITA) grafts use improved the long-term patency of graft as compared with saphenous vein grafts (SVG) use. 1) Balloon angioplasty was firstly performed in 1977 by Andreas Grüentzig. The development of coronary stent overcame acute occlusion by coronary dissection and acute recoil. These device and technical improvement in percutaneous coronary intervention (PCI) has gradually shifted the selection of coronary revascularization procedure from to PCI, especially after the introduction of drug-eluting stents (DES), which could dramatically reduce the rate of restenosis. 2) However, optimal revascularization methods (PCI or ) for severe CAD such as multivessel and/or left main (LM) CAD is still in debate in the current clinical practice. In this review, therefore, we discuss the current status of coronary revascularization and outcome in patients with severe CAD on the basis of the evidence of clinical trials in DES era. II. The SYNTAX trial Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, , Japan doi: /jcoron The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) randomized trial is the first dedicated trial comparing PCI using first-generation DES of paclitaxel-eluting stents (PES) with in patients with LM/3-vessels CAD. 3) In this trial, 1,800 patients were randomly assigned to (n=897) or PCI using PES (n=903), and a composite endpoints of major adverse cardiac and cerebrovascular events () were evaluated as a primary endpoint. Recently published 5-year clinical follow-up demonstrated that the cumulative incidences of (26.9% versus 37.3%, log-rank P<0.0001), myocardial infarction (MI: 3.8% versus 9.7%, log-rank P<0.0001), and repeat revascularization (13.7% versus 25.9%, log-rank P<0.0001) were ly lower in the group than in the PCI group, although those of all-cause death (11.4% versus 13.9%, log-rank P=0.10) and (3.7% versus 2.4%, log-rank P=0.09) were not ly different between the 2 groups. 4) In the SYNTAX trial, however, clinical outcomes of PCI as compared with were quite different between LM and 3-vessels CAD stratum. 4) In the following sections, therefore, we review the clinical outcomes of coronary revascularization for multivessel CAD (including 3-vessels CAD) and LM CAD separately. III. Multivessel disease Several studies reported the clinical outcomes of patients with multivessel CAD after PCI as compared with those after (Table 1). 5-14) In the 3-vessels CAD stratum of the SYNTAX trial, the cumulative 5-year incidence of was ly higher in the PCI group than in the group (37.5% versus 24.2%, P). 10) Furthermore, the cumulative 5-year incidence of all- 267
2 Study NY State Cardiac Registry-3VD (2008) ARTS II (2010) ASAN Multivessel Registry (2011) ASCERT (2012) FREEDOM (2012) SYNTAX-3VD (2014) CREDO-Kyoto Cohort-2 (2015) Yonsei University Registry (2013) Study type Histrical comparison RCT J Jpn Coron Assoc 2015; 21: Table 1 Clinical studies comparing PCI and in multivessel CAD in the DES era Patient profile Follow-up (years) 3VD 1.5 MVD 5 MVD 5 MVD 4 MVD with DM RCT 3VD 5 5 3VD 5 3VD 3 BEST (2015) RCT MVD 4.6 NY State Registry (2015) MVD 2.9 Groups 1G-DES Era (N=5, 202) PCI with DES (N=2, 481) (N=605) PCI with SES (N=607) (N=1, 495) PCI with DES (N=1, 547) (N=86, 244) PCI (N=103, 549, DES: 78%) (N=947) PCI with DES (N=953) (N=545) PCI with PES (N=543) (N=1,154)PCI (N=1,824, DES: 77%) 2G-DES Era OPCAB (N=799) PCI with 2G-DES (N=847) (N=442) PCI with EES (N=438) (N=9,223) PCI with EES (N=9,223) Primary endpoint Death/MI Death s TVR Death 7.9% 10.5% 21.1% 27.5% 14.5% 10.6% 16.4% 20.8% 18.7% 26.6% 24.2% 37.5% 24.0% 28.2% 5.2% 11.5% 10.6% 15.3% 2.9%/year 3.1%/year NA but Mortality 6.0% 7.3% 7.4% 5.5% 11.0% 8.2% 16.4% 20.8% 10.9% 16.3% 9.2% 14.6% 17.5% 20.5% 2.6% 4.6% 5.0% 6.6% 2.9%/year 3.1%/year NA but clinical outcomes of PCI using 2-G DES of everolimus-eluting stents (EES) with. 14) In this using a propensity matched cohort, mortality risk was not ly different between PCI with EES and (3.1%/year versus 2.9%/year, HR: 1.04, 95%CI: , P=0.50), although PCI with EES as compared with was ly associated with higher risk for MI (HR: 1.51, 95%CI: , P) and repeat revascularization (HR: 2.35, 95%CI: , P). On the other hand, the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trial, in which 880 patients with multivessel CAD randomly assigned to PCI using EES or, reported that the risk of PCI with EES relative to for the primary endpoint of death/mi/target-vessel revascularization was ly higher (15.3% versus 10.6%, log-rank P=0.04). 13) IV. Treatment selection according to anatomical complexity In the SYNTAX trial, SYNTAX score based on anatomical complexity of CAD was introduced and successfully stratified the different risk of PCI relative to for clinical outcomes. 10) Reflecting the of the SYNTAX trial, the current clinical guidelines updated the recommendations of PCI for 3-vessels CAD according to SYNTAX score. 15, 16) Discordant with the SYNTAX trial, however, the CREDO-Kyoto registry cohort-2 and the FREEDOM trial could not demonstrate the utility of the SYNTAX score in selecting the mode of revascularizacause death (14.6% versus 9.2%, P=0.006) as well as that of MI (22.0% versus 14.0%, P) was ly higher in the PCI group than in the group. On the other hand, the risk for was not ly different between PCI and (3.0% versus 3.5%, P=0.66). The FREEDOM (the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial was a multi-center randomized clinical trial (RCT) in which 1900 MV- CAD patients with diabetes mellitus (DM) were randomly assigned to undergo PCI using DES or, and reported that the primary endpoint of a composite of death/mi/ was ly lower in the group than in the PCI group (18.7% versus 26.6%, P=0.005). 9) In Japan, the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome Study in Kyoto) registry cohort-2 reported long-term clinical outcomes after PCI and in patients with 3-vessels CAD in DES era. 11) Consistent with the in RCTs and observational studies in foreign countries, the CREDO-Kyoto registry cohort-2 reported that the excess risks of PCI relative to for death/mi/ (hazard ratio [HR]: 1.38 [95% confidence interval (CI): ], P=0.002), all-cause death (HR: 1.38, 95%CI: , P=0.006), MI (HR: 2.81, 95%CI: , P), and any coronary revascularization (HR: 4.10, 95%CI: , P) were 8, 10, 11) even after adjusting for confounders. In the second-generation (2-G) DES era, a large-scale observational in New York State in the United State compared 268
3 Study MAIN- COMPARE: DES stratum (2010) Milan-LMT registry(2010) PRECOMBAT (2011) Study type Table 2 Clinical studies comparing PCI and in LM CAD in the DES era Patient profile Follow-up (years) RCT LM-CAD 2 LE MANS (2011) RCT LM-CAD 1 SYNTAX-LM (2014) CREDO-Kyoto Cohort-2 (2015) PRECOMBAT-2 (2012) Yonsei University Registry (2013) RCT Histrical comparison LM-CAD 1.5 LM-CAD 3 Groups Primary endpoint 1G-DES Era (N=690) PCI with DES (N=784) (N=142) PCI with DES (N=142) (N=300) PCI with SES (N=300) (N=101) PCI with SES (N=100) (N=348) PCI with PES (N=357) (N=640) PCI (N=364, DES: 78%) MACE 2G-DES Era (N=272) PCI with EES (N=334) OPCAB (N=251) PCI with s 2G-DES (N=236) 16.3% 12.7% 38.3% 32.4% 8.1% 12.2% 13.9% 19.0% 31.0% 36.9% 24.1% 34.5% 6.7% 8.9% 3.6% 15.4% (P for noninferiority) Mortality 15.4% 12.1% 18.3% 15.9% 3.4% 2.4% 5.0% 2.0% 14.6% 12.8% 18.0% 25.3% 3.3% 2.2% 2.1% 6.7% NA but not 0.45 (P for noninferiority) NA but not 0.06 tion. 9, 11) Therefore, dedicated prospective randomized trials are necessary to address whether PCI could be a viable option in 3-vessels CAD patients with low/intermediate SYNTAX score. V. Future perspectives in the treatment of multivessel CAD Most previous studies showed the benefit of over PCI in 8, 10, 12, 13, 17) long-term cardiovascular outcomes even in DES era. However, newer adjunctive medical therapies such as novel P2Y12 receptor inhibitors and PCSK9 inhibitors, as well as newer device including newer generation DES and bioresorbable scaffolds might expect to improve clinical outcomes of multivessel CAD patients treated with PCI ) PCI guided by fractional flow reserve (FFR), furthermore, was reported to provide improved clinical outcomes as compared with conventional angiography-guided PCI in multivessel CAD. 22) The currently ongoing FAME 3 trial, in which 1,500 patients with multivessel CAD randomly assign to PCI guided by FFR or, would provide further guidance for treatment for multivessel CAD. VI. Left main coronary artery disease In the LM-CAD stratum (N=705) of the SYNTAX trial, the cumulative 5-year incidences of (36.9% versus 31.0%, P=0.12), all-cause death (12.8% versus 14.6%, P=0.53), and MI (8.2% versus 4.8%, P=0.10) in the PCI group was not ly different with those in the group. 23) The risk of PCI relative to for was ly lower (1.5% versus 4.3%, P=0.03), while the risk for repeat revascularization was ly higher in PCI than (26.7% versus 15.5%, P<0.01). Favorable long-term mortality of LM-CAD patients after PCI was consistently observed in several clinical studies despite of higher risk of PCI relative to for repeat revascularization (Table 2). 17, 23-25) In Japan, The CREDO-Kyoto registry cohort-2 reported longterm clinical outcomes after PCI and in patients with LM CAD in DES era. 17) In the CREDO-Kyoto registry cohort-2, the cumulative 5-year incidences of a composite of death/mi/ (34.5% versus 24.1%, log-rank P) and all-cause death (25.3% versus 18.0%, log-rank P=0.001) were ly higher in the PCI group than in the group. After adjusting for confounders, the risk of PCI relative to for all-cause death was not ly different (HR: 1.32, 95%CI: , P=0.16), although that for death/mi/ was still signifi- 269
4 cantly higher (HR: 1.48, 95%CI: , P=). VII. Treatment selection according to anatomical complexity Consistent with the SYNTAX trial, the CREDO-Kyoto registry cohort-2 showed the utility of SYNTAX score for risk stratification and selection of mode of revascularization procedure in LM-CAD. 17, 23) In the CREDO-Kyoto registry cohort-2, the adjusted risk for death/mi/ was not ly different between PCI and in low (HR: 1.76, 95%CI: , P=0.0504), or intermediate (HR: 1.53, 95%CI: , P=0.14) SYNTAX scores, whereas it was ly higher in PCI than for patients with high SYNTAX score (HR: 2.09, 95%CI: , P=0.004). The current clinical guidelines updated the recommendations of PCI for LM CAD 15, 16) according to SYNTAX score. VIII. Future perspectives in the treatment of LM CAD The previous studies reporting favorable long-term clinical outcomes after PCI using DES suggest that further shifting to PCI could be possible without impairing long-term outcome in selected patients with LM CAD. The currently ongoing EXCEL trial, in which 2,600 LM CAD patients with SYNTAX score<33 randomly assign to PCI with EES or, would provide further guidance for treatment for LM CAD. IX. Conclusion After the introduction of DES in daily clinical practice, the selection of mode of coronary revascularization has dramatically changed over time in Japan. 2) The currently available evidence based on the of clinical studies comparing PCI with in DES era suggest that is still standard treatment for advanced multivessel CAD, while PCI can be a reasonable alternative to in selected patients with LM CAD. More appropriate indication for coronary revascularization and selection of revascularization procedure as well as stringent adherence to evidence-based medicines might lead further improvement of outcome in patients with severe CAD. All authors declare no conflict of interest. References 1) Cameron A, Davis KB, Green G, et al: Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. N Engl J Med 1996; 334: ) Shiomi H, Morimoto T, Makiyama T, et al: Evolution in practice patterns and long-term outcomes of coronary revascularization from bare-metal stent era to drug-eluting stent era in Japan. Am J Cardiol 2014; 113: ) Serruys PW, Morice MC, Kappetein AP, et al: Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360: ) Mohr FW, Morice MC, Kappetein AP, et al: Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. The Lancet 2013; 381: ) Hannan EL, Wu C, Walford G, et al: Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med 2008; 358: ) Serruys PW, Onuma Y, Garg S, et al: 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol 2010; 55: ) Park DW, Kim YH, Song HG, et al: Long-term comparison of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization: 5-year outcomes from the Asan Medical Center-Multivessel Revascularization Registry. J Am Coll Cardiol 2011; 57: ) Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al: Comparative effectiveness of revascularization strategies. N Engl J Med 2012 ; 366: ) Farkouh ME, Domanski M, Sleeper LA, et al: Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367: ) Head SJ, Davierwala PM, Serruys PW, et al: Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J 2014; 35: ) Shiomi H, Morimoto T, Furukawa Y, et al: Comparison of five-year outcome of percutaneous coronary intervention with coronary artery bypass grafting in triple-vessel coronary artery disease (from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/ Registry Cohort-2). Am J Cardiol 2015; 116: ) Yi G, Joo HC, Youn YN, et al: Stent versus off-pump coronary bypass grafting in the second-generation drug-eluting stent era. Ann Thorac Surg 2013; 96: ) Park SJ, Ahn JM, Kim YH, et al: Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015; 372: ) Bangalore S, Guo Y, Samadashvili Z, et al: Everolimus-eluting stents or bypass surgery for multivessel coronary disease. N Engl J Med 2015; 372: ) Windecker S, Kolh P, Alfonso F, et al: 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35: ) Fihn SD, Gardin JM, Abrams J, et al: 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, 270
5 American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126: e ) Shiomi H, Morimoto T, Furukawa Y, et al: Comparison of percutaneous coronary intervention with coronary artery bypass grafting in unprotected left main coronary artery disease - 5-year outcome from CREDO-Kyoto PCI/ Registry Cohort-2. Circ J 2015; 79: ) Roe MT, Armstrong PW, Fox KA, et al: Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med 2012; 367: ) Wallentin L, Becker RC, Budaj A, et al: Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361: ) Robinson JG, Farnier M, Krempf M, et al: Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N Engl J Med 2015; 372: ) Kimura T, Kozuma K, Tanabe K, et al: A randomized trial evaluating everolimus-eluting Absorb bioresorbable scaffolds vs. everolim- us-eluting metallic stents in patients with coronary artery dis ease: ABSORB Japan. Eur Heart J ) Tonino PA, De Bruyne B, Pijls NH, et al: Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009; 360: ) Morice MC, Serruys PW, Kappetein AP, et al: Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation 2014; 129: ) Kim YH, Park DW, Ahn JM, et al: Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis. The PRE- COMBAT-2 (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease). JACC Cardiovasc Interv 2012; 51: ) Park SJ, Kim YH, Park DW, et al: Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med 2011; 364:
PCI for LMCA lesions A Review of latest guidelines and relevant evidence
HCS Working Group Seminars Met Hotel, Thursday 14 th February 2013 PCI for LMCA lesions A Review of latest guidelines and relevant evidence Vassilis Spanos Interventional Cardiologist, As. Director 3 rd
More informationControversies in Cardiac Surgery
Controversies in Cardiac Surgery 3 years after SYNTAX : Percutaneous Coronary Intervention for Multivessel / Left main stem Coronary artery disease Pro ESC Congress 2010, 28 August 1 September Stockholm
More informationRationale for Percutaneous Revascularization ESC 2011
Rationale for Percutaneous Revascularization Marie Claude Morice, Massy FR MD, FESC, FACC ESC 2011 Paris Villepinte - 27-31 August, 2011 Massy, France Potential conflicts of interest I have the following
More informationPCI vs. CABG From BARI to Syntax, Is The Game Over?
PCI vs. CABG From BARI to Syntax, Is The Game Over? Seung-Jung Park, MD, PhD Professor of Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea PCI vs CABG Multi-Vessel Disease
More informationΑΓΓΕΙΟΠΛΑΣΤΙΚΗ ΣΤΟ ΔΙΑΒΗΤΙΚΟ ΑΣΘΕΝΗ
ΑΓΓΕΙΟΠΛΑΣΤΙΚΗ ΣΤΟ ΔΙΑΒΗΤΙΚΟ ΑΣΘΕΝΗ Νίκος Μεζίλης MD, FESC Κλινική Άγιος Λουκάς Why diabetes is associated with restenosis endothelial dysfunction metabolic alterations accelerated platelet deposition
More informationLeft Main PCI vs. CABG: Real World
Management of Patients with Stable CAD Left Main PCI vs. CABG: Real World Marco Roffi, MD, FESC University Hospital Geneva, Switzerland SYNTAX-LMT The SYNTAX trial included a pre-specified subgroup of
More informationMise à Jour sur le traitement du Pluritronculaire Philippe Généreux, MD
Mise à Jour sur le traitement du Pluritronculaire Philippe Généreux, MD Columbia University Medical Center and The Cardiovascular Research Foundation, New York, USA Hôpital du Sacré-Coeur de Montréal,
More informationUnprotected Left Main Coronary Artery Disease in Patients With Low Predictive Risk of Mortality
Unprotected Left Main Coronary Artery Disease in Patients With Low Predictive Risk of Mortality Shun Watanabe, MD, Tatsuhiko Komiya, MD, Genichi Sakaguchi, MD, PhD, and Takeshi Shimamoto, MD, PhD Department
More informationBenefit of Performing PCI Based on FFR
Benefit of Performing PCI Based on FFR William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center Benefit of FFR-Guided PCI FFR-Guided PCI vs. Angiography-Guided
More informationImportant LM bifurcation studies update
8 th European Bifurcation Club 12-13 October 2012 - Barcelona Important LM bifurcation studies update I Sheiban E-mail: isheiban@yahoo.com Unprotected LM Percutaneous Revascularization What is important
More informationKomplexe Koronarintervention heute: Von Syntax zu bioresorbierbaren Stents
Komplexe Koronarintervention heute: Von Syntax zu bioresorbierbaren Stents Prof. Dr. med. Julinda Mehilli Medizinische Klinik und Poliklinik I Klinikum der Universität München Campus Großhadern Key Factors
More informationPCI for Left Main Coronary Artery Stenosis. Jean Fajadet Clinique Pasteur, Toulouse, France
PCI for Left Main Coronary Artery Stenosis Jean Fajadet Clinique Pasteur, Toulouse, France Athens, October 19, 2018 Left Main Coronary Artery Disease Significant unprotected left main coronary artery disease
More informationΔημήτριος Αγγοσράς, FETCS
ΣΕΜΙΝΑΡΙΟ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ Δημήτριος Αγγοσράς, FETCS Επίκοσρος Καθηγηηής Καρδιοτειροσργικής Ιαηρική Πανεπιζηημίοσ Αθηνών Πανεπιζηημιακό Γενικό Νοζοκομείο Αηηικόν Randomized Controlled Trials (RCTs) Why
More informationPerspective of LM stenting with Current registry and Randomized Clinical Data
Asian Pacific TCT Perspective of LM stenting with Current registry and Randomized Clinical Data Patrick W. Serruys MD PhD Yoshinobu Onuma MD Seung-Jung Park MD, PhD 14:48-15:00, 2009 Symposium Arena, Level
More informationNew Generation Drug- Eluting Stent in Korea
New Generation Drug- Eluting Stent in Korea Young-Hak Kim, MD, PhD Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Purpose To briefly introduce the
More informationEXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017
EXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017 Igor F. Palacios, MD Director of Interventional Cardiology Professor of Medicine Massachusetts
More informationCite this article as:
doi: 10.21037/acs.2018. 05.12 Cite this article as: Ngu JM, Sun LY, Ruel M. Pivotal contemporary trials of percutaneous coronary intervention vs. coronary artery bypass grafting: a surgical perspective..
More informationComparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Disease
1282 SHIOMI H et al. Circulation Journal ORIGINAL ARTICLE Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp Cardiovascular Intervention Comparison of Percutaneous Coronary Intervention
More informationImpact of Chronic Kidney Disease on Long-Term Outcome in Coronary Bypass Candidates Treated with Percutaneous Coronary Intervention
Original Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Impact of Chronic Kidney Disease on Long-Term Outcome in Coronary Bypass Candidates Treated with Percutaneous Coronary
More informationSurgery Grand Rounds
Surgery Grand Rounds Coronary Artery Bypass Grafting versus Coronary Artery Stenting Charles Ted Lord, R1 Coronary Artery Disease Stenosis of epicardial vessels Metabolic & hematologic Statistics 500,000
More informationPercutaneous coronary intervention in patients with multi-vessel coronary artery disease: a focus on physiology
REVIEW Korean J Intern Med 2018;33:851-859 Percutaneous coronary intervention in patients with multi-vessel coronary artery disease: a focus on physiology Yun-Kyeong Cho and Chang-Wook Nam Division of
More informationJournal of the American College of Cardiology Vol. 57, No. 21, by the American College of Cardiology Foundation ISSN /$36.
Journal of the American College of Cardiology Vol. 57, No. 21, 2011 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.01.033
More informationAdecade ago, many cardiac surgeons believed
CABG for Multivessel CAD Recent studies show that CABG is still preferred over PCI for most patients. BY SUBHASIS CHATTERJEE, MD; JOHN C. ALEXANDER, MD; AND PAUL J. PEARSON, MD, PHD Adecade ago, many cardiac
More informationRevascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease
Impact of Angiographic Complete Revascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease Young-Hak Kim, Duk-Woo Park, Jong-Young Lee, Won-Jang
More informationAccepted Manuscript. Coronary dialysis patients: CABG or PCI? A complex question for a complex scenario
Accepted Manuscript Coronary dialysis patients: CABG or PCI? A complex question for a complex scenario Francesco Formica, MD, Stefano D Alessandro, MD, FECTS. PII: S0022-5223(18)32554-6 DOI: 10.1016/j.jtcvs.2018.09.050
More informationThe MAIN-COMPARE Study
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationBetter CABGs vs Better PCI Devices
CABG vs PCI 2017 Multivessel Coronary Disease Better CABGs vs Better PCI Devices ACC New York, Dec 8, 2017 No Disclosures CABG vs PCI 2017 Stable Multivessel Coronary Disease 1. Are These The two Critical
More informationLeft Main Intervention: Where are we in 2015?
Left Main Intervention: Where are we in 2015? David A. Cox, MD FSCAI Director, Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown, PA Fall Fellows Course Laa
More informationSurgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome
Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome Chris C. Cook, MD Associate Professor of Surgery Director, CT Residency Program, WVU ACOI 10/17/18 No Disclosures
More informationUnprotected LM intervention
Unprotected LM intervention Guideline for COMBAT Seung-Jung Park, MD, PhD Professor of Internal Medicine, Seoul, Korea Current Recommendation for unprotected LMCA Stenosis Class IIb C in ESC guideline
More informationCan Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
More information7-Year Follow-up From a Randomized Trial of Sirolimus-Eluting vs. Everolimus-Eluting Stents in Patients With Coronary Artery Disease (RESET)
7-Year Follow-up From a Randomized Trial of Sirolimus-Eluting vs. Everolimus-Eluting Stents in Patients With Coronary Artery Disease (RESET) Hiroki Shiomi, MD Kyoto University Graduate School of Medicine
More informationDeclaration of conflict of interest NONE
Declaration of conflict of interest NONE Claudio Muneretto MD, PhD Director of Division of Cardiac Surgery University of Brescia Medical School Italy Hybrid Chymera Different features and potential advantages
More informationCoronary Stent Choice in Patients With Diabetes Mellitus
Rome Cardiology Forum 2014 Coronary Stent Choice in Patients With Diabetes Mellitus Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical Trials Unit Bern Bern University
More informationRelations of Interest
Relations of Interest Consulting Fees on my behalf go to the Cardiovascular Research Center Aalst Contracted Research between the Cardiovascular Research Center Aalst and several pharmaceutical and device
More informationLeft Main Disease: what is left to surgery? Prof. Jacques Monségu CardioVascular Institute Grenoble, France
Left Main Disease: what is left to surgery? Prof. Jacques Monségu CardioVascular Institute Grenoble, France Background on LM stenosis 5% of patients undergoing angiography Of the myocardium 80% Bifurcation
More informationThe MAIN-COMPARE Registry
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationImplications of the New ESC/EACTS Guidelines for Myocardial Revascularization in 2011
Implications of the New ESC/EACTS Guidelines for Myocardial Revascularization in 2011 Prof. Dr. Volkmar Falk Klinik für Herz- und Gefäßchirurgie, Universitätsspital Zürich, Schweiz In 2004 headlines were
More informationPercutaneous coronary intervention in left main disease: SYNTAX, PRECOMBAT, EXCEL and NOBLE combined cardiology and cardiac surgery perspective
Perspective Percutaneous coronary intervention in left main disease: SYNTAX, PRECOMBAT, EXCEL and NOBLE combined cardiology and cardiac surgery perspective Duk-Woo Park 1, Jung-Min Ahn 1, Seung-Jung Park
More informationNOBLE and EXCEL: The debate for excellence in dealing with left main stenosis
O P E N A C C E S S 1 Aswan Heart Centre, Aswan, Egypt 2 Sultan Qaboos University Hospital, Muscat, Sultanate of Oman 3 Cairo University, Cairo, Egypt *Email: hatem.hosny@aswanheartcentre.com Lessons from
More informationLong-term outcomes of PCI vs. CABG for ostial/midshaft lesions in unprotected left main coronary artery
Journal of Geriatric Cardiology (2017) 14: 254 260 2017 JGC All rights reserved; www.jgc301.com Research Article Open Access Long-term outcomes of PCI vs. CABG for ostial/midshaft lesions in unprotected
More informationUnprotected Left Main Stenting: Patient Selection and Recent Experience. Alaide Chieffo. S. Raffaele Hospital, Milan, Italy
Unprotected Left Main Stenting: Patient Selection and Recent Experience Alaide Chieffo S. Raffaele Hospital, Milan, Italy Class IIa (Level B) AHA/ACC 2005 Guidelines Left Main CAD The use of PCI for pts
More informationDiabetic Patients: Current Evidence of Revascularization
Diabetic Patients: Current Evidence of Revascularization Alexandra J. Lansky, MD Yale University School of Medicine University College of London The Problem with Diabetic Patients Endothelial dysfunction
More informationMultivessel Coronary Artery Disease : CABG. Zürich, F. Siclari MD
Multivessel Coronary Artery Disease : CABG Zürich, 10.06.2015 F. Siclari MD Coronary Artery Ruptured Plaque Pathological process with definite subsequent vascular changes most of them irreversible CABG
More informationhigh SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin Turin / Italy
What to do with patients with high SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin San Giovanni Battista Hospital Turin / Italy Who are the patients with high SYNTAX
More informationFFR Incorporating & Expanding it s use in Clinical Practice
FFR Incorporating & Expanding it s use in Clinical Practice Suleiman Kharabsheh, MD Consultant Invasive Cardiology Assistant professor, Alfaisal Univ. KFHI - KFSHRC Concept of FFR Maximum flow down a vessel
More informationPCI or CABG for unprotected left main coronary artery disease? new evidence justifies a change in perspective
Editorial PCI or CABG for unprotected left main coronary artery disease? new evidence justifies a change in perspective R. Andrew Archbold Barts Heart Centre, St. Bartholomew s Hospital, West Smithfield,
More informationIncidence and Treatment for LM In-Stent
Incidence and Treatment for LM In-Stent Restenosis Corrado Tamburino, MD, PhD Full Professor of Cardiology, Director of Postgraduate School of Cardiology Chief Cardiovascular Department, Director Cardiology
More informationPCI or CABG for severe unprotected left main coronary artery disease: making sense of the NOBLE and EXCEL trials
Editorial PCI or CABG for severe unprotected left main coronary artery disease: making sense of the NOBLE and EXCEL trials Anthony A. Holmes, Sripal Bangalore Leon H. Charney Division of Cardiology, New
More informationThe SYNTAX-LE MANS Study
The SYNTAX-LE MANS Study Synergy Between PCI with TAXUS Express and Cardiac Surgery: Late (15-month) Left Main Angiographic Substudy A. Pieter Kappetein, MD, PhD Erasmus MC, Rotterdam, NL SYNTAX-LE MANS
More informationAssessing Myocardium at Risk: Applying SYNTAX
Assessing Myocardium at Risk: Applying SYNTAX Farouc Jaffer MD PhD FSCAI FACC FAHA Associate Professor of Medicine, Harvard Medical School Director, CAD Program and Chronic Total Occlusion PCI Program
More informationCHAPTER 2. Heart Team: Concept and Utility MAIN BENEFITS BARRIERS. Praveen Chandra, Rashmi Xavier, Manoj Dhanger, Rohit Goel, Naresh Trehan
CHAPTER 2 Praveen Chandra, Rashmi Xavier, Manoj Dhanger, Rohit Goel, Naresh Trehan Heart Team: Concept and Utility The concept of The Heart Team approach is gaining popularity in present-day cardiology
More informationTRATAMIENTO INVASIVO ENFERMEDAD ISQUEMICA ESTABLE. Jonathan Poveda CLINICA BIBLICA 2015
TRATAMIENTO INVASIVO ENFERMEDAD ISQUEMICA ESTABLE Jonathan Poveda CLINICA BIBLICA 2015 COURAGE First coronary angioplasty lesion (circles) two days before (A), immediately after (B), and one month after
More informationFFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium
FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium Conflict of Interest Institutional research grants and speaker s fee from St. Jude Medical and Boston Scientic to Cardiovascular
More informationLM stenting - Cypher
LM stenting - Cypher Left main stenting with BMS Since 1995 Issues in BMS era AMC Restenosis and TLR (%) 3 27 TLR P=.282 Restenosis P=.71 28 2 1 15 12 Ostium 5 4 Shaft Bifurcation Left main stenting with
More informationCristiano Spadaccio 1,2, Umberto Benedetto 3. Introduction
Perspective Coronary artery bypass grafting () vs. percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease: quo vadis? a review of the evidences on coronary artery disease
More informationHCS Working Group Seminars Macedonia Pallas Hotel, Friday 21 st February Drug-eluting stents Are they all equal?
HCS Working Group Seminars Macedonia Pallas Hotel, Friday 21 st February 2014 Drug-eluting stents Are they all equal? Vassilis Spanos Interventional Cardiologist, As. Director 3 rd Cardiology Clinic Euroclinic
More informationReview. Open Access. Beom Jun Lee 1, Peter Herbison 2, Cheuk-Kit Wong 1. 1 Introduction
Journal of Geriatric Cardiology (2014) 11: 83 89 2014 JGC All rights reserved; www.jgc301.com Review Open Access Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention
More informationClinical Seminar. Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective
Clinical Seminar Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical
More informationWhen should we indisputably perform CABG? Quand faut-il indiscutablement opérer? Dr Hakim BENAMER
When should we indisputably perform CABG? Quand faut-il indiscutablement opérer? Dr Hakim BENAMER ICPS, Massy ICV-GVM La Roseraie, Aubervilliers Hôpital FOCH, Suresnes Disclosure Statement of Financial
More informationChapter 29 Left Main Intervention in the Light of EXCEL and NOBLE Trials
Chapter 29 Left Main Intervention in the Light of EXCEL and NOBLE Trials DEBDATTA BHATTACHARYYA AYAN KAR The incidence of angiographically significant left main stenosis described in various studies has
More informationDES in Diabetic Patients
DES in Diabetic Patients Charles Chan, M.D., FACC Gleneagles Hospital Singapore TCT ASIA PACIFIC 2007 Why do diabetics have worse outcome after PCI? More extensive atherosclerosis and diffuse disease Increase
More informationAbstract. Roman S Tarasov and Vladimir I Ganyukov. Research Institute for Complex Issues of Cardiovascular Diseases, Russia
Chapter 2 Prognostic Role of Initial and Residual Syntax Score in Patients with ST-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention Roman S Tarasov and Vladimir
More informationEffect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial
Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial Myeong-Ki Hong, MD. PhD on behalf of the IVUS-XPL trial investigators
More informationMaster Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April
Master Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April 14 2011 Coronary interventions in patients with diabetes Lars Rydén Karolinska Institutet Stockholm, Sweden
More informationANGIOPLASY SUMMIT 2007 TCT ASIA PACIFIC. Seoul, Korea: April The problem is exaggerated: Data from Real World Registries
ANGIOPLASY SUMMIT 007 TCT ASIA PACIFIC Seoul, Korea: 5-7 7 April 007 15 min Plenary Session: State-of of-the-art Lectures The problem is exaggerated: Data from Real World Registries Antonio Colombo Centro
More informationBern-Rotterdam Cohort Study
Bern-Rotterdam Cohort Study Newer generation everolimus-eluting stents eliminate the risk of very late stent thrombosis compared with early generation sirolimus-eluting and paclitaxel-eluting stents Lorenz
More informationDrug Eluting Stents Sometimes Fail ESC Stockholm 29 Set 2010 Stent Thrombosis Alaide Chieffo
Drug Eluting Stents Sometimes Fail ESC Stockholm 29 Set 2010 Stent Thrombosis 11.45-12.07 Alaide Chieffo San Raffaele Scientific Institute, Milan, Italy Historical Perspective 25 20 15 10 5 0 Serruys 1991
More informationFFR-Guided PCI. 4 th Imaging and Physiology Summit October 29 th, 2010 Seoul, Korea. Stanford
4 th Imaging and Physiology Summit October 29 th, 2010 Seoul, Korea FFR-Guided PCI William F. Fearon, M.D. Associate Professor Division of Cardiovascular Medicine University Medical Center Disclosure Statement
More informationDrug eluting stents From revolution to evolution. Current limitations
Drug eluting stents From revolution to evolution Current limitations Eric Eeckhout Centre Hospitalier Universitaire Vaudois Lausanne - Switzerland eric.eeckhout@chuv.ch Overview Historical perspective
More informationCardiovascular Health Nova Scotia Update to Antiplatelet Sections of the Nova Scotia Guidelines for Acute Coronary Syndromes, 2008.
Cardiovascular Health Nova Scotia Update to Antiplatelet Sections of the Nova Scotia Guidelines for Acute Coronary Syndromes, 2008. ST Elevation Myocardial Infarction (STEMI)-Acute Coronary Syndrome Guidelines:
More informationEverolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Disease
The new england journal of medicine original article Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Disease Sripal Bangalore, M.D., M.H.A., Yu Guo, M.A., Zaza Samadashvili, M.D.,
More informationPCIs on Intermediate Lesions NCDR Cath-PCI Registry
Practical Application Of Coronary Physiology in The Cath Lab Talal T Attar, MD, MBA, FACC PCIs on Intermediate Lesions NCDR Cath-PCI Registry Fraction of stenoses 50-70% treated with PCI without further
More informationWhat is an Ideal Heart Team? Our Approach and Recent Results against Coronary Artery Disease
Review J Jpn Coron Assoc 2017; 23: 212-217 What is an Ideal Heart Team? Our Approach and Recent Results against Coronary Artery Disease Hiroyasu Misumi, Kohei Abe, Manabu Yamazaki, Kunihiko Yoshino and
More informationThe BIO revolution: bioadsorbable stents. Federico Conrotto Cardiologia 2 Città della Salute e della Scienza di Torino
The BIO revolution: bioadsorbable stents Federico Conrotto Cardiologia 2 Città della Salute e della Scienza di Torino BVS stent (Abbot Vascular) Strut Material: Poly-L-Lactic acid Coating Material: Poly-D,L-lactide
More informationCoronary Physiology the current state of play
Coronary Physiology the current state of play Background The concept of using the trans-stenotic pressure gradient in a diseased coronary artery as a measure to guide percutaneous coronary intervention
More informationKurdistan Technique for the Treatment of Unprotected Trifurcation Left Main Stem Coronary Artery Lesion: Case Report
World Journal of Cardiovascular Diseases, 2014, 4, 483-491 Published Online August 2014 in SciRes. http://www.scirp.org/journal/wjcd http://dx.doi.org/10.4236/wjcd.2014.49058 Kurdistan Technique for the
More informationFFR in Multivessel Disease
FFR in Multivessel Disease April, 26 2013 Coronary Physiology in the Catheterization Laboratory Location: European Heart House, Nice, France Pim A.L. Tonino, MD, PhD Hartcentrum, Eindhoven, the Netherlands
More informationPCI for Long Coronary Lesion
PCI for Long Coronary Lesion Shift of a General Idea with the Introduction of DES In the Bare Metal Stent Era Higher Restenosis Rate With Increasing Stent Length and Decreasing Stent Area Restenosis.6.4.2
More informationDrug-eluting stents (DESs) show a lower incidence of
ADULT CARDIAC Comparison of Off-pump Coronary Artery Bypass Grafting With Percutaneous Coronary Intervention Versus Drug-Eluting Stents for Three-Vessel Coronary Artery Disease Gijong Yi, MD, Young-Nam
More informationUpgrade of Recommendation
Challenges in LM PCI Decision-making process for stenting Young-Hak Kim, MD, PhD, Heart Institute, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea Upgrade of Recommendation for
More informationTLR des Stents Actifs
TLR des Stents Actifs No Conflict of Interest Target Lesion Revascularization DES vs BMS Stettler C et al. Lancet 2007;370:937-48 N=18,023 58% 70% SES vs BMS: HR=0.30 (0.24-0.37), p
More informationCost-Effectiveness of Fractional Flow Reserve
Cost-Effectiveness of Fractional Flow Reserve William F. Fearon, MD Associate Professor of Medicine Director, Interventional Cardiology Stanford University Medical Center Cost-Effectiveness of FFR What
More information2010 Korean Society of Cardiology Spring Scientific Session Korea Japan Joint Symposium. Seoul National University Hospital Cardiovascular Center
2010 Korean Society of Cardiology Spring Scientific Session Korea Japan Joint Symposium Does Lt Late Cth Catch up Exist Eiti in DES? : Quantitative Coronary Angiography Analysis Kyung Woo Park, MD Cardiovascular
More informationComparison of Coronary Artery Bypass Grafting With Drug-Eluting Stent Implantation for the Treatment of Multivessel Coronary Artery Disease
Comparison of Coronary Artery Bypass Grafting With Drug-Eluting Stent Implantation for the Treatment of Multivessel Coronary Artery Disease Jeong Hoon Yang, MD, Hyeon-Cheol Gwon, MD, Soo Jin Cho, MD, Joo
More informationGender-Based Outcomes in Percutaneous Coronary Intervention with Drug-Eluting Stents (from the National Heart, Lung, and Blood Institute Dynamic
Gender-Based Outcomes in Percutaneous Coronary Intervention with Drug-Eluting Stents (from the National Heart, Lung, and Blood Institute Dynamic Registry) J. D. Abbott, et al. Am J Cardiol (2007) 99;626-31
More informationManagement of cardiovascular disease - coronary interventions -
Master Classes in Preventive Cardiology I Management of diabetes in patients with CVD European Heart House Management of cardiovascular disease - coronary interventions - Francesco Cosentino MD, PhD, FESC
More informationVCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital
VCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital Complex PCI: Multivessel Disease George W. Vetrovec, MD. Kimmerling Chair of Cardiology VCU Pauley Heart Center Virginia
More informationAbbott Vascular. PROTOCOL EXCEL Clinical Trial
Abbott Vascular PROTOCOL Clinical Trial Evaluation of XIENCE PRIME or XIENCE V versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization PCI (1 st gen DES) vs. CABG for Left
More informationManagement of stable CAD FFR guided therapy: the new gold standard
Management of stable CAD FFR guided therapy: the new gold standard Suleiman Kharabsheh, MD Director; CCU, Telemetry and CHU Associate professor of Cardiology, Alfaisal Univ. KFHI - KFSHRC Should patients
More informationPredictive value of SYNTAX score II for clinical outcomes in octogenarian undergoing percutaneous coronary intervention
Journal of Geriatric Cardiology (2016) 13: 733 739 2016 JGC All rights reserved; www.jgc301.com Research Article Open Access Predictive value of SYNTAX score II for clinical outcomes in octogenarian undergoing
More informationDiabetes mellitus (DM) is a powerful independent. Stents, surgery, and optimal medical therapy in diabetes. Original Article
Original Article Heart Metab. (2015) 68:9-14 Stents, surgery, and optimal medical therapy in diabetes Sonya N. Burgess, BSc, MBChB, FRACP; John K. French, BMedSc, MBChB, MSc, PhD Department of Cardiology,
More informationControversies in Coronary Revascularization. Atlanta CCU April 15, 2016
Controversies in Coronary Revascularization Atlanta CCU April 15, 2016 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology, Emory University Director, Cardiac Catheterization
More informationCoronary Artery Disease: Revascularization (Teacher s Guide)
Stephanie Chan, M.D. Updated 3/15/13 2008-2013, SCVMC (40 minutes) I. Objectives Coronary Artery Disease: Revascularization (Teacher s Guide) To review the evidence on whether percutaneous coronary intervention
More informationLeft Main Intervention: Will it become standard of care?
Left Main Intervention: Will it become standard of care? David Cox, MD FSCAI, FACC Director, Interventional Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown,
More informationΣεμινάριο Ομάδων Εργασίας Fractional Flow Reserve (FFR) Σε ποιούς ασθενείς; ΔΗΜΗΤΡΗΣ ΑΥΖΩΤΗΣ Επιστ. υπεύθυνος Αιμοδυναμικού Τμήματος, Βιοκλινική
ΕΛΛΗΝΙΚΗΚΑΡΔΙΟΛΟΓΙΚΗΕΤΑΙΡΕΙΑ Σεμινάριο Ομάδων Εργασίας 2011 Fractional Flow Reserve (FFR) Σε ποιούς ασθενείς; ΔΗΜΗΤΡΗΣ ΑΥΖΩΤΗΣ Επιστ. υπεύθυνος Αιμοδυναμικού Τμήματος, Βιοκλινική GUIDELINES ON MYOCARDIAL
More informationNova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Antiplatelet Section of the Guidelines)
Cardiovascular Health Nova Scotia Guideline Update Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Antiplatelet Section of the Guidelines) Authors: Dr. M. Love, Dr. I. Bata, K. Harrigan
More informationPROMUS Element Experience In AMC
Promus Element Luncheon Symposium: PROMUS Element Experience In AMC Jung-Min Ahn, MD. University of Ulsan College of Medicine, Heart Institute, Asan Medical Center, Seoul, Korea PROMUS Element Clinical
More informationFractional Flow Reserve: Basics, FAME 1, FAME 2. William F. Fearon, MD Associate Professor Stanford University Medical Center
Fractional Flow Reserve: Basics, FAME 1, FAME 2 William F. Fearon, MD Associate Professor Stanford University Medical Center Conflict of Interest Advisory Board for HeartFlow Research grant from St. Jude
More informationSupplementary Online Content
Supplementary Online Content Valle JA, Tamez H, Abbott JD, et al. Contemporary use and trends in unprotected left main coronary artery percutaneous coronary intervention in the United States: an analysis
More information