This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pietro Giorgio Malvindi Joel Dunning Nicola Vitale Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Malvindi, P. G. Articles by Vitale, N. Search for Related Content PubMed PubMed Citation Articles by Malvindi, P. G. Articles by Vitale, N. Related Collections Cardiac - other Education Coronary disease

For which patients with left main stem disease is percutaneous intervention rather than coronary artery bypass grafting the better option?

^a Department of Cardiac Surgery, Policlinico Hospital, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
^b Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel.: +39-080-5592392; fax: +39-080-5595087.

E-mail address: Nicola_Vitale{at}lycos.co.uk (N. Vitale).

A best evidence topic in cardiac surgery was written according to a structured protocol. The topic addressed was to identify the patients with left main stem disease for which percutaneous intervention would be a better option than coronary artery bypass grafting. Altogether 665 papers were found using the reported search, of which 15 presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. We conclude that if a bare metal stent is used for left main stenting the mortality at one year may be from 3% to over 28% in reported series. The restenosis rate of the bare metal stent in the left main position is around 20% at one year. There are some early series and randomized studies of drug eluting stents for left main stem lesions and the restenosis rate is reported to be around 10%. The European Society of Cardiology in their 2005 percutaneous intervention guidelines state that coronary bypass grafting is the procedure of choice for left main stem disease and only patients with a prohibitively high surgical risk should be considered. We consider that with such high restenosis rates, and with short-term follow-up in such low numbers and short periods compared to coronary artery bypass grafting, left main stenting should only be used as a last resort in patients turned down for coronary artery bypass grafting after full assessment by a cardiac surgeon due to prohibitive co-morbidities.

Key Words: Evidence-based medicine; Left main coronary disease; Coronary artery bypass; Percutaneous coronary intervention; Coronary stent

This article has been cited by other articles:

				R. P. Akhtar, M. S. Naqshband, A. R. Abid, Z. Tufail, A. Waheed, and J. S. Khan Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience Asian Cardiovasc Thorac Ann, October 1, 2009; 17(5): 472 - 476. [Abstract] [Full Text] [PDF]