Unprotected Left Main Coronary Artery Disease in Patients With Low Predictive Risk of Mortality
|
|
- Logan Woods
- 5 years ago
- Views:
Transcription
1 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 of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan Background. There has been an increasing use of percutaneous coronary intervention with drug-eluting stent (DES) in patients with unprotected left main coronary artery disease. We assessed whether coronary artery bypass grafting (CABG) would be superior to percutaneous coronary intervention with first-generation DES in patients with unprotected left main coronary artery disease. Methods. Between January 2003 and December 2007, a total of 295 patients with unprotected left main coronary artery disease were treated with Kurashiki Central Hospital, Okayama, Japan. Among these patients, 169 and 126 underwent CABG and percutaneous coronary intervention with DES, respectively. The average Society of Thoracic Surgeons predictive risk of mortality score was %. We defined higher-risk and lower-risk patients as those with Society of Thoracic Surgeons predictive risk of mortality scores higher than 2.3% (CABG, n 48; percutaneous coronary intervention, n 28) and lower than 2.3% (CABG, n 121; percutaneous coronary intervention, n 98), respectively. Survival, major adverse cardiac-related events, and target lesion revascularization were analyzed by the Kaplan-Meier method. Results. Between-group differences in favor of CABG were seen with respect to the rate of major adverse cardiac-related events and target lesion revascularization in both strata. In patients with lower scores according to the Society of Thoracic Surgeons predictive risk of mortality, the cardiac death-free survival rate was significantly higher in CABG. Conclusions. In this 5-year single-center experience, CABG is recommended for unprotected left main coronary artery disease, especially in patients with low scores in the Society of Thoracic Surgeons predictive risk of mortality. (Ann Thorac Surg 2012;94: ) 2012 by The Society of Thoracic Surgeons Coronary artery bypass grafting (CABG) is considered the optimum revascularization treatment for patients with de novo left main disease, three-vessel disease, or both [1]. Furthermore, of those undergoing coronary angiography, 4% are found to have left main coronary artery disease [2]. Published cohort studies have found that mortality rates are similar at 1, 2, and 5 years of follow-up; however, the risk of needing targetvessel revascularization is significantly higher with stenting than with CABG. The new American College of Cardiology Foundation/American Heart Association guidelines for CABG were released in 2011 and recommend CABG for unprotected left main coronary artery [ULMCA] disease in class I patients regardless of their risk and anatomy. Meanwhile, percutaneous coronary intervention (PCI) for ULMCA is recommended in class IIa patients if the SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score is under 22 and the Society of Thoracic Surgeons predictive risk of mortality score (STS PROM) Accepted for publication June 26, Presented at the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28 Feb 1, Address correspondence to Dr Komiya, Department of Cardiovascular Surgery, Kurashiki Central Hospital, Miwa, Kurashiki, Okayama , Japan; komiya@kchnet.or.jp. is over 5%, and in class IIb patients if the SYNTAX is under 33 and the STS PROM is over 2%. The guidelines recommend estimating the operative risk for all CABG candidates by using a standard instrument such as STS PROM [3]. The usability of the STS PROM score as a long-term predictor was revealed in a recent report [4]. The purpose of this study was to compare the long-term outcomes between CABG and PCI with drug-eluting stents (DES) for ULMCA disease among patients stratified according to the STS PROM scores. Patients and Methods The Institutional Review Board of Kurashiki Central Hospital approved this study and waived individual consent because this study was retrospective. A total of 295 consecutive patients with ULMCA disease were treated in our institution between January 2003 and December Among these patients, 169 underwent CABG (the CABG group), and 126 underwent PCI with DES. The choice of treatment was made by the cardiologists. The decision for patients to undergo PCI instead of CABG was based either on the patient s or the cardiologist s preference or on the high risk associated with CABG. All patients were divided into two strata according to STS PROM. The mean and standard deviation of 2012 by The Society of Thoracic Surgeons /$36.00 Published by Elsevier Inc
2 1928 WATANABE ET AL Ann Thorac Surg TREATMENT FOR ULMCA IN LOWER STS PROM 2012;94: the STS PROM was % (the 75 value was also 2.3%). According to the STS database, the average score of CABG patients was 2.24% [4], which was almost the same as our average. Therefore, we defined the cutoff value of STS PROM as 2.3%. Patients were divided into two strata: higher-risk patients with a mortality rate higher than 2.3% (CABG, n 48; PCI, n 28) and lower-risk patients with a mortality rate lower than 2.3% (CABG, n 121; PCI, n 98). Patients who had prior PCI or CABG, a concomitant surgical procedure, or acute myocardial infarction were excluded. Propensity-Matched Analysis We performed propensity matching for the patients and analyzed limited patients outcomes as a subgroup analysis. The factors used for propensity matching were age, sex, hypertension, hyperlipidemia, SYNTAX score, diabetes mellitus, hemodialysis, ejection fraction, estimated glomerular filtration rate (egfr), cerebrovascular disease, and peripheral artery disease. After propensity matching, the number of CABG and PCI patients was 82 in each group. Percutaneous Revascularization Patients in the DES group were implanted with either a sirolimus-eluting stent (Cypher; Cordis, Miami Lakes, FL), a paclitaxel-eluting stent (TAXUS; Boston Scientific Corp, Natick, MA), or a biolimus-eluting stent (Bio Matrix; Biosensors Interventional Technologies Pte, Ltd.; Singapore). Aspirin in combination with clopidogrel sulfate or ticlopidine was administered throughout the study period to patients if they experienced no side effects from antiplatelet medications. Angiographic follow-up was scheduled at 3, 8, and 20 months after PCI. Surgical Revascularization CABG was performed through a median sternotomy in all cases. The left internal mammary artery was used to bypass the left anterior descending artery in all possible cases. For patients younger than 60 years of age, we attempted to use bilateral internal thoracic artery and radial artery grafts. For those under 70 years of age, we tried to use no more than two arterial grafts. The off-pump technique was used in elective cases and in patients with good cardiac function. In emergent cases, patients with low ejection fraction, or both, cardiopulmonary bypass was used. Postoperative antiplatelet medication involved only aspirin in patients receiving coumadin or both aspirin and ticlopidine for 3 months in patients not receiving warfarin, after which ticlopidine was discontinued. Study Endpoints The primary clinical endpoint was freedom from major adverse cardiac-related events (MACE) and death. We defined MACE as death, myocardial infarction, and target lesion revascularization (TLR). The TLR was defined as any revascularization performed on the treated lesion. Statistical Analyses Comparisons of categoric variables were performed by use of the 2 test or Fisher s exact test. Continuous variables were analyzed by Student s t test. Survival and event-free survival were analyzed by the Kaplan-Meier method; the log-rank test was used for comparisons between groups. Risk of mortality was analyzed by Cox proportional hazard analysis. All analyses were conducted with SAS software, version 5.0 (SAS Institute, Inc, Cary, NC). Follow-Up Follow-up was obtained by means of a direct telephone questionnaire or at the outpatient clinic. The median duration of follow-up was months; the follow-up rate was 98.6%. Results Patient Characteristics The patients baseline clinical characteristics are summarized in Table 1. Few differences were observed between the two groups. Cerebrovascular disease was more prevalent in the CABG group. The mean STS PROM score was higher in the CABG group, but the difference was Table 1. Baseline Characteristics of Patients Undergoing CABG and PCI With DES Characteristic CABG (n 169) DES (n 126) p Value Age, years Male sex, 123 (73.7) 95 (75.4) Hypertension, 120 (71.9) 96 (76.2) Hypercholesterolemia, 88 (52.7) 49 (38.9) Diabetes mellitus, 61 (36.5) 44 (34.9) egfr Hemodialysis, 11 (6.6) 9 (7.1) Cerebrovascular 37 (22.2) 14 (11.1) disease, Peripheral artery 19 (11.4) 11 (8.7) disease, Ejection fraction, n (%) Left main only, 8 (4.7) 18 (14.3) Left main 1 vessel 14 (28.6) 35 (71.4) disease, 2 vessel disease, 47 (27.8) 49 (38.9) vessel disease, 100 (59.2) 24 (19.0) EuroSCORE STS PROM SYNTAX score CABG coronary artery bypass grafting; DES drug eluting stent; egfr estimated glomerular filtration rate; EuroSCORE European system for cardiac operative risk evaluation; PCI percutaneous coronary intervention; STS PROM The Society of Thoracic Surgeons predictive risk of mortality; SYNTAX synergy between percutaneous coronary intervention with TAXUS and cardiac surgery.
3 Ann Thorac Surg WATANABE ET AL 2012;94: TREATMENT FOR ULMCA IN LOWER STS PROM 1929 not statistically significant. However, the distribution of the stenosis sites was significantly different between the two groups. The number of patients who had stenosis only on the left main coronary artery was higher in the DES group. Meanwhile, more patients with multivessel disease were in the CABG group. However, no significant difference was observed in the SYNTAX scores. CABG and PCI Procedures In the CABG group, the off-pump technique was used in 70% of the patients; the on-pump beating technique, in 12%; and the on-pump arrested heart technique, in 17%. A left or right internal mammary artery graft was used for revascularization of the left anterior descending artery in all cases. All arterial grafting was performed in 49% of the cases. In the DES group, 31 patients had stenosis in an ostial or body lesion of the left main trunk, and 95 patients had stenosis on a distal lesion of the left main trunk. All ostial and body stenoses were treated with lone stent. For distal lesions, a two-stent technique was used in 42% of the cases. Kaplan-Meier Analysis The 5-year survival, the cardiac death-free survival, the MACE-free survival, and the TLR-free survival rates were 82.6%, 93.8%, 80.8%, and 91.7%, respectively, in the CABG group and 77.2%, 91.9%, 54.5%, and 70.5%, respectively, in the DES group (Fig 1). No significant difference in mortality was observed. However, the MACE and TLR rates were significantly higher in the DES group (p ). Stratification of Patients According to STS PROM The 5-year survival and the cardiac death-free survival rates in the patients with the lower STS PROM scores were 92.4% and 97.9%, respectively, in the CABG group and 85.3% and 94.9%, respectively, in the DES group. There was no significant difference in survival (p 0.065) (Fig 2A, B). In terms of cardiac death-free survival, CABG was favorable for patients with a lower STS PROM score (p 0.025) (Fig 2C, D). The MACE and TLR rates were significantly higher in the DES group, irrespective of the patient s risk (Fig 3). Fig 1. (A) Freedom from all-cause death in the entire cohort. (B) Freedom from cardiac death in the entire cohort. (C) Freedom from MACE in the entire cohort. (D) Freedom from target lesion revascularization in the entire cohort. (CABG coronary artery bypass grafting; DES drug-eluting stent; MACE major adverse cardiac-related events; TLR target lesion revascularization.)
4 1930 WATANABE ET AL Ann Thorac Surg TREATMENT FOR ULMCA IN LOWER STS PROM 2012;94: Fig 2. (A) Freedom from all-cause death in patients with lower STS PROM scores. (B) Freedom from all-cause death in patients with higher STS PROM scores. (C) Freedom from cardiac death in patients with lower STS PROM scores. (D) Freedom from cardiac death in patients with higher STS PROM scores. (CABG coronary artery bypass grafting; DES drug-eluting stent; STS PROM The Society of Thoracic Surgeons predictive risk of mortality.) Propensity-Matched Patients There were no significant differences in survival and cardiac death-free survival (p and p 0.655, respectively) (Table 2, Fig 4A, B). The MACE and TLR rates were significantly higher in the DES group, irrespective of the patient s risk (Fig 4C, D). Cox Proportional Hazard Analysis The result of the Cox proportional hazard analysis is shown in Figure 5. The superiority of CABG was evident in the patients with a lower STS PROM score. Comment Although CABG has been considered the gold standard for unprotected left main cardiac disease revascularization, more recently PCI has emerged as a possible alternative mode of revascularization in carefully selected patients [3]. Several studies have suggested that coronary stenting is feasible for patients with ULMCA stenosis [5]. Moreover, the results of recent randomized control trials suggest that major clinical outcomes in selected patients with ULMCA disease are similar between CABG and PCI at 1- to 2-year follow-up but that repeat revascularization rates are higher after PCI than after CABG [1, 3, 6, 7]. However, randomized control trials with an extended follow-up of 5 years are required to provide definitive conclusions about the optimal treatment of ULMCA, but none have yet been conducted [3]. In this retrospective study involving patients with ULMCA stenosis, no significant differences in long-term all-cause and cardiac mortality were observed between the CABG and DES groups. The MACE and TLR rates were higher in the DES group. However, long-term cardiac mortality was significantly higher in the DES patients with a lower STS PROM score. Survival analysis of the entire cohort showed no survival benefit for CABG as a treatment of ULMCA disease, similar to previous randomized control trials [1, 6, 7]. The all-cause mortality rate for 5 years was 17.4%, comparable with the value of a previous report [4]. Moreover, the MACE and TLR rates
5 Ann Thorac Surg WATANABE ET AL 2012;94: TREATMENT FOR ULMCA IN LOWER STS PROM 1931 Fig 3. (A) Freedom from MACE in patients with lower STS PROM scores. (B) Freedom from MACE in patients with higher STS PROM scores. (C) Freedom from target lesion revascularization in patients with lower STS PROM scores. (D) Freedom from target lesion revascularization in patients with higher STS PROM scores. (CABG coronary artery bypass grafting; DES drug-eluting stent; MACE major adverse cardiac-related events; TLR target lesion revascularization; STS PROM The Society of Thoracic Surgeons predictive risk of mortality.) were significantly higher in the DES group, which are also similar to the results of previous reports [1, 6 8]. To the best of our knowledge, this is first report to stratify patients by STS PROM scores to compare CABG and DES in the treatment of ULMCA. STS PROM is a very useful tool as a predictor not only of 30-day mortality but also of long-term mortality [4]. In this study, we defined the cutoff value at 2.3% because the average STS PROM score for our entire cohort was 2.3%, with the 75 value at 2.3%. The average of the STS CABG cohort was 2.24%, and the current guidelines recommend PCI for class IIb patients in whom the STS PROM is over 2% and the SYNTAX score is low to intermediate. Hence, our definition of the cutoff value was relatively feasible. The Kaplan-Meier analysis after stratification based on the STS PROM scores showed that CABG was better for cardiac survival in patients with lower STS PROM scores. In a recent review, low-risk patients with good left ventricular function, nondistal and non-calcified left main stenosis, ostial left main lesions, midshaft left main lesions, and very few additional lesions on the other coronary vessel were defined as favorable for stenting. However, in our study, the superiority of CABG was seen only in the lower-risk patients. The analysis of the higher-risk patients showed no showed significant differences, although this might have resulted from the small sample size. To date, limited data exist regarding the long-term outcomes of coronary stenting with DES. Furthermore, the long-term safety of DES has been questioned by recent reports that suggest an increased risk of late stent thrombosis, mortality, and myocardial infarction. [9, 10] The LMCA differs from the other coronary arteries by its relatively higher elastic tissue content, which can explain the elastic recoil and the high restenosis rate after balloon angioplasty [11]. Therefore, stenting in the ULMCA should be done only in carefully selected patients. Most of our patients underwent implantation with first-generation DESs. However, the new generation of DESs, known as dedicated bifurcation stents, and an improvement in procedural techniques will probably improve the clinical outcome [11]. However, the long-
6 1932 WATANABE ET AL Ann Thorac Surg TREATMENT FOR ULMCA IN LOWER STS PROM 2012;94: Table 2. Baseline Characteristics of Propensity-Score Matched Patients Undergoing CABG and PCI With DES Characteristic CABG (n 82) DES (n 82) p Value Age, years Male sex, 66 (80.5) 66 (80.5) Hypertension, 63 (76.8) 58 (70.7) Hypercholesterolemia, 41 (50.0) 38 (46.3) Diabetes mellitus, 29 (35.4) 32 (39.0) egfr Hemodialysis, 4 (4.9) 4 (4.9) Cerebrovascular disease, n 14 (17.1) 12 (14.6) (%) Peripheral artery disease, n 6 (7.32) 9 (11.0) (%) Ejection fraction STS PROM Syntax score CABG coronary artery bypass grafting; DES drug eluting stent; egfr estimated glomerular filtration rate; PCI percutaneous coronary intervention; STS PROM The Society of Thoracic Surgeons predictive risk of mortality. term results of such devices in the treatment of ULMCA disease remain unknown. The long-term results from the EXCEL (Evaluation of Xience Prime vs Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials may provide further insights into the optimal treatment for patients with left main disease [1]. The present study had several limitations. First, this study was not a prospective, randomized study, and the sample size was small. Hence, the evaluation of a large number of patients will be necessary. A heterogenous cohort with a small number of subjects, three types of DESs, differences in baseline criteria (cardiovascular disease, ejection fraction, type of coronary heart disease, European system for cardiac operative risk evaluation), the use of different grafts, on/off pump technique, two types of antiplatelet therapy (given for only 3 months) are factors known to interfere with the chosen endpoint; hence, a larger dataset is needed to overcome this major methodologic issue in a retrospective study. Second, the study had patient selection bias. The median follow-up time was shorter in the DES group. This is because more patients received CABG in 2003 and Fig 4. (A) Freedom from all-cause death in propensity-matched patients. (B) Freedom from cardiac death in propensity-matched patients. (C) Freedom from MACE in propensity-matched patients. (D) Freedom from target lesion revascularization in propensity-matched patients. (CABG coronary artery bypass grafting; DES drug-eluting stent; MACE major adverse cardiac-related events; TLR target lesion revascularization.)
7 Ann Thorac Surg WATANABE ET AL 2012;94: TREATMENT FOR ULMCA IN LOWER STS PROM 1933 CABG: 48 PCI: 28 Higher STS = 2.3% Lower O utcome Hazard Ra o (95% CI) P value for Interac on All cause death 081(04116) 0.81 ( ) C ardiac death 0.63 ( ) 0.44 M ACE 0.53 ( ) 0.04 TLR 024( ( ) All cause d eath 0.46 ( ) 0.07 Cardiac death 0.16 ( ) 0.04 Fig 5. Cox proportional hazard analysis. (CABG coronary artery bypass grafting; CI confidence interval; DES drug-eluting stent; MACE major adverse cardiac-related event; PCI percutaneous coronary intervention; STS The Society of Thoracic Surgeons; TLR target lesion revascularization.) CABG: 121 PCI: 98 M ACE 0.19 ( ) < T LR 0.28 ( ) CABG Be er DES Be er The number of patients who received CABG in 2003 and 2004 was 72. However, the number of patients who received DES was only 10. Because our hospital has produced excellent results in operating on patients in Japan, there appears to be some value in examining the results of such a single institution. Moreover, this study reflected the real-world results in Japan. Nonetheless, a large, 5-year randomized trial will be necessary to confirm the present results. In this 5-year single-center experience, CABG seemed to be a favorable treatment for ULMCA disease, especially in patients with lower STS PROM scores. Cardiologists should consider the patients surgical risk and selection of PCI carefully. CABG should be used to treat ULMCA in patients with lower STS PROM scores. References 1. Kappetein AP, Mohr FW, Feldman TE, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J 2011;17: Ragosta M, Dee S, Sarembock IJ, et al. Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv 2006;68: Hillis LD, Smith PK, Anderson JL, et al. ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2011;124:e Puskas JD, Kilgo PD, Thourani VH, et al. The Society of Thoracic Surgeons 30-Day Predicted Risk of Mortality Score also predicts long-term survival. Ann Thorac Surg 2012;93: Park SJ, Park DW. Percutaneous coronary intervention with stent implantation versus coronary artery bypass surgery for treatment of left main coronary artery disease: is it time to change guidelines? Circ Cardiovasc Interv 2009;2: Buszman PE, Kiesz SR, Bochenek A, et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol 2008;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: Lee MS, Jamal F, Kedia G, et al. Comparison of bypass surgery with drug-eluting stents for diabetic patients with multivessel disease. Int J Cardiol 2007;123: Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007;369: Lagerqvist B, James SK, Stenestrand U, Lindback J, Nilsson T, Wallentin L. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 2007;356: Fajadet J, Chieffo A. Current management of left main coronary artery disease. Eur Heart J 2012;33:36 50.
LM 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 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 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 informationPCI 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 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 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 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 informationCoronary Revascularization for Patients with Severe Coronary Artery Disease: An Overview of Current Evidence and Treatment Strategies
Review J Jpn Coron Assoc 2015; 21: 267-271 Coronary Revascularization for Patients with Severe Coronary Artery Disease: An Overview of Current Evidence and Treatment Strategies Hiroki Shiomi, Takeshi Kimura
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 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 informationLeft Main and Bifurcation Summit I. Lessons from European LM Studies
Left Main and Bifurcation Summit I Apr 29 8.56-9.09 Lessons from European LM Studies Alaide Chieffo, MD S. Raffaele Hospital, Milan, Italy Nothing to disclose regarding this presentation Lesion Location
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 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 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 informationSupplementary Material to Mayer et al. A comparative cohort study on personalised
Suppl. Table : Baseline characteristics of the patients. Characteristic Modified cohort Non-modified cohort P value (n=00) Age years 68. ±. 69.5 ±. 0. Female sex no. (%) 60 (0.0) 88 (.7) 0.0 Body Mass
More informationISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions
Julinda Mehilli, MD Deutsches Herzzentrum Technische Universität Munich Germany ISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions Background Left main
More informationClinical Study Age Differences in Long Term Outcomes of Coronary Patients Treated with Drug Eluting Stents at a Tertiary Medical Center
Aging Research Volume 2013, Article ID 471026, 4 pages http://dx.doi.org/10.1155/2013/471026 Clinical Study Age Differences in Long Term Outcomes of Coronary Patients Treated with Drug Eluting Stents at
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 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 informationLong-Term Outcomes After Stenting Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease
Journal of the American College of Cardiology Vol. 56, No. 17, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.03.097
More informationSupplementary Table S1: Proportion of missing values presents in the original dataset
Supplementary Table S1: Proportion of missing values presents in the original dataset Variable Included (%) Missing (%) Age 89067 (100.0) 0 (0.0) Gender 89067 (100.0) 0 (0.0) Smoking status 80706 (90.6)
More informationNine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions
Journal of Geriatric Cardiology (2017) 14: 35 41 2017 JGC All rights reserved; www.jgc301.com Research Article Open Access Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large
More informationImportance of the third arterial graft in multiple arterial grafting strategies
Research Highlight Importance of the third arterial graft in multiple arterial grafting strategies David Glineur Department of Cardiovascular Surgery, Cliniques St Luc, Bouge and the Department of Cardiovascular
More informationLe# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy
Le# main treatment with Stentys stent Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Disclosure Statement of Financial Interest I, Carlo Briguori DO NOT have a financial interest/ arrangement
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 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 informationSCAAR: Lower late and very late stent thrombosis rates with new generation drug eluting stents compared to bare metal stents
SCAAR: Lower late and very late stent thrombosis rates with new generation drug eluting stents compared to bare metal stents Christoph Varenhorst, Giovanna Sarno, Göran Olivecrona, Per Tornvall, Johan
More informationCoronary Artery Bypass Grafting Versus Coronary Implantation of Sirolimus-Eluting Stents in Patients with Diabetic Retinopathy
Coronary Artery Bypass Grafting Versus Coronary Implantation of Sirolimus-Eluting Stents in Patients with Diabetic Retinopathy Takayuki Ohno, MD, Shinichi Takamoto, MD, Noboru Motomura, MD, Minoru Ono,
More informationCase Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)?
Cronicon OPEN ACCESS CARDIOLOGY Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Valentin Hristov* Department of Cardiology, Specialized
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 informationAbstract Background: Methods: Results: Conclusions:
Two-Year Clinical and Angiographic Outcomes of Overlapping Sirolimusversus Paclitaxel- Eluting Stents in the Treatment of Diffuse Long Coronary Lesions Kang-Yin Chen 1,2, Seung-Woon Rha 1, Yong-Jian Li
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 informationTCTAP Upendra Kaul MD,DM,FACC,FSCAI,FAMS,FCSI
Indian TUXEDO Trial In Medically Treated Diabetics Upendra Kaul MD,DM,FACC,FSCAI,FAMS,FCSI Executive Director and Dean Escorts Heart Institute & Medical Research Center and Fortis Hospitals, New Delhi
More informationSTENTYS for Le, Main Sten2ng. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy
STENTYS for Le, Main Sten2ng Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Disclosure Statement of Financial Interest I, Carlo Briguori DO NOT have a financial interest/ arrangement or affilia2on
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 informationClinical Investigations
Clinical Investigations Clinical Outcomes for Single Stent and Multiple Stents in Contemporary Practice Qiao Shu Bin, MD; Liu Sheng Wen, MD; Xu Bo, BS; Chen Jue, MD; Liu Hai Bo, MD; Yang Yue Jin, MD; Chen
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 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 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 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 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 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 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 informationPCI for Left Anterior Descending Artery Ostial Stenosis
PCI for Left Anterior Descending Artery Ostial Stenosis Why do you hesitate PCI for LAD ostial stenosis? LAD Ostial Lesion Limitations of PCI High elastic recoil Involvement of the distal left main coronary
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 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 informationDrug-Coated Balloons for Small Coronary Artery Disease: BASKET-SMALL 2
Drug-Coated Balloons for Small Coronary Artery Disease: BASKET-SMALL 2 Raban V. Jeger,Ahmed Farah, Marc-Alexander Ohlow, Norman Mangner, Sven Möbius-Winkler, GregorLeibundgut, Daniel Weilenmann, JochenWöhrle,
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 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 informationRCA Disease and Unprotected LM Stenting
Original Article RCA Disease and Unprotected LM Stenting Acta Cardiol Sin 2011;27:14 20 Coronary Heart Disease The Clinical Significance of Right Coronary Artery Stenosis on the Prognosis of Patients with
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 informationComparison of Coronary Artery Bypass Surgery and Percutaneous Drug-Eluting Stent Implantation for Treatment of Left Main Coronary Artery Stenosis
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 1, NO. 3, 2008 2008 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/08/$34.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2008.02.007 Comparison
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 informationPCI in Left Main Disease: Are We There Yet?
PCI in Left Main Disease: Are We There Yet? Moderator Mark A. Turco, MD Director Center for Cardiac & Vascular Research Washington Adventist Hospital Takoma Park, Maryland Panelists David E. Kandzari,
More informationLong-Term Clinical Outcomes of Sirolimus- Versus Paclitaxel-Eluting Stents for Patients With Unprotected Left Main Coronary Artery Disease
Journal of the American College of Cardiology Vol. 54, No. 9, 2009 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2009.04.071
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 informationSummary HTA. Drug-eluting stents vs. coronary artery bypass-grafting. HTA-Report Summary. Gorenoi V, Dintsios CM, Schönermark MP, Hagen A
Summary HTA HTA-Report Summary Drug-eluting stents vs. coronary artery bypass-grafting in coronary heart disease Gorenoi V, Dintsios CM, Schönermark MP, Hagen A Scientific background The coronary heart
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 informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
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 informationOlive registry: 3-years outcome of BTK intervention in Japan. Osamu Iida, MD Kansai Rosai Hospital Amagasaki, Hyogo, Japan
Olive registry: 3-years outcome of BTK intervention in Japan Osamu Iida, MD Kansai Rosai Hospital Amagasaki, Hyogo, Japan What is the optimal treatment for the patient with critical limb ischemia (CLI)?
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 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 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 informationCulprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome
Culprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome Hiroyuki Okura*, MD; Nobuya Matsushita**,MD Kenji Shimeno**, MD; Hiroyuki Yamaghishi**, MD Iku Toda**,
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 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 informationin an Unyielding Patient Dr Jason See, Dr Goh Yew Seong, Dr Rohit Khurana Changi General Hospital Singapore
Unrelenting Left Main Disease in an Unyielding Patient Dr Jason See, Dr Goh Yew Seong, Dr Rohit Khurana Changi General Hospital Singapore Clinical History 72 years old Chinese lady Background and CV Risk
More informationJournal of the American College of Cardiology Vol. 35, No. 5, by the American College of Cardiology ISSN /00/$20.
Journal of the American College of Cardiology Vol. 35, No. 5, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00546-5 CLINICAL
More informationDavide Capodanno, MD; Maria Elena Di Salvo, MD; Glauco Cincotta, MD; Marco Miano, MD; Claudia Tamburino, MD; Corrado Tamburino, MD, PhD, FESC, FSCAI
Usefulness of the SYNTAX Score for Predicting Clinical Outcome After Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease Davide Capodanno, MD; Maria Elena Di Salvo, MD;
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 informationLong-Term Safety and Efficacy of Stenting Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease
Journal of the American College of Cardiology Vol. 56, No. 2, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.04.004
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 informationJournal of the American College of Cardiology Vol. 47, No. 8, by the American College of Cardiology Foundation ISSN /06/$32.
Journal of the American College of Cardiology Vol. 47, No. 8, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.11.066
More informationIntegrated Use of IVUS and FFR for LM Stenting
Integrated Use of IVUS and FFR for LM Stenting Gary S. Mintz, MD Cardiovascular Research Foundation Four studies have highlighted the inaccuracy of angiography in the assessment of LMCA disease Fisher
More information388-1 Poongnap-dong, Songpa-gu, Seoul, , Republic of Korea b Department of Medicine, Changi General Hospital, Singapore
International Journal of Cardiology 126 (2008) 224 228 www.elsevier.com/locate/ijcard Percutaneous coronary intervention with stenting of left main coronary artery with drug-eluting stent in the setting
More informationInfluence of Planned Six-Month Follow-Up Angiography on Late Outcome After Percutaneous Coronary Intervention A Randomized Study
Journal of the American College of Cardiology Vol. 38, No. 4, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(01)01476-0 Influence
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 informationUpdate interventional Cardiology Hans Rickli St.Gallen
Update interventional Cardiology 2012 Hans Rickli St.Gallen 26.11.2012 Review of Literature ESC-Highlights TCT/AHA-Highlights Update interventional cardiology 2012 Structural Heart Disease Transcatheter
More informationSYNTAX score before decision making! Corrado Tamburino, MD, PhD
SYNTAX score in left main - Tamburino TCT Asia Pacific Seoul, 27 April 2011 Slide 1 SYNTAX score before decision making! Corrado Tamburino, MD, PhD Full Professor of Cardiology, Director of Postgraduate
More informationWhat oral antiplatelet therapy would you choose? a) ASA alone b) ASA + Clopidogrel c) ASA + Prasugrel d) ASA + Ticagrelor
76 year old female Prior Hypertension, Hyperlipidemia, Smoking On Hydrochlorothiazide, Atorvastatin New onset chest discomfort; 2 episodes in past 24 hours Heart rate 122/min; BP 170/92 mm Hg, Killip Class
More informationJournal of the American College of Cardiology Vol. 47, No. 4, by the American College of Cardiology Foundation ISSN /06/$32.
Journal of the American College of Cardiology Vol. 47, No. 4, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.09.072
More informationNon-LM bifurcation studies of importance in 2011
7th European Bifurcation Club 14-15 October 2011 LISBON Goran Stankovic MD, PhD Non-LM bifurcation studies of importance in 2011 October 15 th : 08:00 08:10 DKCRUSH-II: A Prospective Randomized Trial of
More informationJournal of the American College of Cardiology Vol. 46, No. 5, by the American College of Cardiology Foundation ISSN /05/$30.
Journal of the American College of Cardiology Vol. 46, No. 5, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.06.009
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 informationDEB experience in Gachon Universtiy Gil Hospital (in ISR) Soon Yong Suh MD., PhD. Heart Center Gachon University Gil Hospital Seoul, Korea.
DEB experience in Gachon Universtiy Gil Hospital (in ISR) Soon Yong Suh MD., PhD. Heart Center Gachon University Gil Hospital Seoul, Korea. In-stent restenosis (ISR) Remains important issue even in the
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 informationTiming of Surgery After Percutaneous Coronary Intervention
Timing of Surgery After Percutaneous Coronary Intervention Deepak Talreja, MD, FACC Bayview/EVMS/Sentara Outline/Highlights Timing of elective surgery What to do with medications Stopping anti-platelet
More informationstent (stent fracture) clopidogrel in stent restenosis drug eluting stent(des) (overlap) mail:
stent (MD) (MD) clopidogrel (stent fracture) in stent restenosis drug eluting stent() stent post dilation, angulated) (overlap) mail: mehrdadsaravi@gmail.com J Babol Univ Med Sci; 11(5); Dec-Jan 2009-2010
More information3/23/2017. Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate Europace Oct;14(10): Epub 2012 Aug 24.
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
More informationAngelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
More informationDrug-Eluting Stents Versus Bilateral Internal Thoracic Grafting for Multivessel Coronary Disease
Drug-Eluting Stents Versus Bilateral Internal Thoracic Grafting for Multivessel Coronary Disease Itzhak Herz, MD, Yaron Moshkovitz, MD, Dan Loberman, MD, Gideon Uretzky, MD, Rony Braunstein, PhD, Alberto
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 informationSURGICAL MYOCARDIAL REVASCULARIZATION: ARTERIAL VS VENOUS GRAFTS, SINGLE VS MULTIPLE GRAFTS?
SURGICAL MYOCARDIAL REVASCULARIZATION: ARTERIAL VS VENOUS GRAFTS, SINGLE VS MULTIPLE GRAFTS? Luigi Martinelli Chief, Dept. of Surgery Istituto Clinico Ligure di Alta Specialità RAPALLO During 1987 2006,
More informationΑΝΤΙΜΕΤΩΠΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΝΟΣΟ ΣΤΕΛΕΦΟΥΣ
ΑΝΤΙΜΕΤΩΠΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΝΟΣΟ ΣΤΕΛΕΦΟΥΣ Δ. ΤΣΙΚΑΔΕΡΗΣ MD,FESC ΘΕΣΣΑΛΟΝΙΚΗ 2012 Although LM patients population treated with stenting is usually reported as a single, homogeneous subgroup, LM disease encompasses
More informationJournal of the American College of Cardiology Vol. 57, No. 12, by the American College of Cardiology Foundation ISSN /$36.
Journal of the American College of Cardiology Vol. 57, No. 12, 2011 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.10.041
More informationJournal of the American College of Cardiology Vol. 47, No. 7, by the American College of Cardiology Foundation ISSN /06/$32.
Journal of the American College of Cardiology Vol. 47, No. 7, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.05.102
More informationEffect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary PCI
Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary PCI Dr Sasha Koul, MD Dept of Cardiology, Lund University Hospital, Lund, 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 information