Left Main Coronary Artery Disease: Secular Trends in Patient Characteristics, Treatments, and Outcomes.
Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease, and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and serious composite outcomes, a higher rate of stroke with CABG, and a higher rate of repeat revascularization with PCI. These results have been translated to the current guideline recommendation that PCI is a reasonable alternative to CABG in patients with low to intermediate anatomic complexity. However, how the characteristics, treatment, and clinical outcomes of patients with unprotected LMCA disease have evolved over time has not yet been fully evaluated. We therefore described secular trends in the characteristics and long-term outcomes of unprotected LMCA disease using "real-world" clinical experience from the IRIS-MAIN (Interventional Research Incorporation Society-Left MAIN Revascularization) registry together with a broad review of this topic.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Pil Hyung
PH
Lee
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jung-Min
JM
Ahn
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Mineok
M
Chang
Division of Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Seunghee
S
Baek
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Sung-Han
SH
Yoon
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Soo-Jin
SJ
Kang
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Seung-Whan
SW
Lee
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Young-Hak
YH
Kim
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Cheol Whan
CW
Lee
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Seong-Wook
SW
Park
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: dwpark@amc.seoul.kr.
Duk-Woo
DW
Park
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Seung-Jung
SJ
Park
D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
clinical decision making; coronary artery bypass; coronary disease; percutaneous coronary intervention; revascularization; stents