Percutaneous Coronary Intervention (PCI) Versus Redo Coronary Artery Bypass Grafting (CABG) in “Protected” Left Main (PLM) Coronary Disease

2009 ◽  
Vol 18 ◽  
pp. S69-S70
Author(s):  
M. Freeman ◽  
H.M.O. Farouque ◽  
G.C. Shardey ◽  
J.A. Smith ◽  
N. Andrianopoulos ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Disease ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Percutaneous Coronary

Functional Revascularisation – The Key to Improving Percutaneous Coronary Intervention Outcomes

2009 ◽  
Vol 5 (1) ◽  
pp. 63
Author(s):  
Margaret B McEntegart ◽  
Keith G Oldroyd ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Disease ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Percutaneous Coronary

Recent coronary revascularisation trials have questioned the benefit of percutaneous coronary intervention (PCI) over medical therapy in chronic stable angina (CSA) and its non-inferiority to coronary artery bypass grafting (CABG) in left main and three-vessel coronary disease. This raises the question of how to further improve PCI outcomes in the drug-eluting stent era. The Fractional Flow Reserve (FFR) versus Angiography for Multivessel Evaluation (FAME) study has shown that PCI guided by FFR, rather than by angiography alone, reduces major adverse cardiac events (MACE). This suggests that revascularisation guided by functional assessment may be the key to improving PCI outcomes. Indeed, cross-study extrapolation of the benefits of FFR guidance in FAME to the Clinical Outcomes Utilizing Revascularisation and Aggressive Drug Evaluation (COURAGE) and PCI versus Coronary Artery Bypass Grafting for Severe Coronary Artery Disease (SYNTAX) trials supports the hypothesis that with FFR guidance PCI can provide added benefit over medical therapy in CSA, and can achieve noninferiority to CABG in left main and three-vessel coronary disease.

scholarly journals The EXCEL Trial: The Surgeons’ Perspective

2020 ◽  
Vol 15 ◽  
Author(s):  
Marjan Jahangiri ◽  
Krishna Mani ◽  
Martin T Yates ◽  
Justin Nowell
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Left Main Stem Disease

There have been several investigations comparing the efficacy of percutaneous coronary intervention and coronary artery bypass grafting surgery for treatment of left main stem disease. This includes the Evaluation of XIENCE versus Coronary Artery Bypass Graft Surgery for Effectiveness of Left Main Revascularizaton (EXCEL) trial, which has garnered significant controversy surrounding its experimental design and reporting of its results. The authors review the methodology, results, caveats and statements on the EXCEL trial. They also review the other trials in the management of left main stem disease comparing percutaneous coronary intervention with coronary artery bypass grafting, as well as the SYNTAX score and its role in future guidelines for revascularisation. These findings have significant implications for current practice, influencing the growing role for multidisciplinary team meeting and allowing clinicians and patients to make the right choice.

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