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Hohri Y, Yamagishi M, Maeda Y, Asada S, Hongu H, Numata S, Yaku H. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6580210. [PMID: 35512199 PMCID: PMC9387505 DOI: 10.1093/icvts/ivac119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Corresponding author. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. Tel: +81-75-2515752; fax: +81-75-2575910; e-mail: (Y. Hohri)
| | - Masaaki Yamagishi
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Batra K, Saboo SS, Kandathil A, Canan A, Hedgire SS, Chamarthy MR, Kalva SP, Abbara S. Extrinsic compression of coronary and pulmonary vasculature. Cardiovasc Diagn Ther 2021; 11:1125-1139. [PMID: 34815964 DOI: 10.21037/cdt-20-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022]
Abstract
Coronary artery disease from atherosclerosis induced stenosis remains the leading cause of acute coronary syndrome (ACS) and death worldwide, however extrinsic compression of coronary arteries from adjacent anatomical and pathological structures is an infrequent but important diagnosis to be aware of, especially given the nonspecific symptoms of chest pain that mimic angina in patients with pulmonary hypertension (PHT) and congenital heart disease. Non-invasive CT angiography is an invaluable diagnostic tool for detection of coronary artery compression, pulmonary artery dilatation and pulmonary vascular compression. Although established guidelines are not available for management of left main coronary artery (LMCA) compression syndrome, percutaneous coronary intervention and stent implantation remain a feasible option for the treatment, specifically for patients with a high surgical risk. Treatment of pulmonary vein or artery compression is more varied and determined by etiology. This review article is focused on detailed discussion of extrinsic compression of coronary arteries, mainly the LMCA and brief discussion on pulmonary vasculature compression by surrounding anatomical and pathological entities, with focus on pathophysiology, clinical features, complications and role of imaging in its diagnosis and management.
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Affiliation(s)
- Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sachin S Saboo
- Division of Cardiothoracic Imaging, Department of Radiology, University of Texas Health Science Center, TX, USA
| | - Asha Kandathil
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arzu Canan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Murthy R Chamarthy
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical, School, Boston, MA, USA
| | - Suhny Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Siepe M, Sardari Nia P. Shine on you crazy diamond! How the EACTS journals will continue to shine with the new Editors-in-Chief. Eur J Cardiothorac Surg 2021; 59:1-3. [PMID: 33279990 DOI: 10.1093/ejcts/ezaa399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center University Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
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Riley JYJ, Leong K, Mortensen KH, Ariff B, Gopalan D. Native aorto-ostial coronary lesions on CT coronary angiogram. Br J Radiol 2021; 94:20210211. [PMID: 33989055 PMCID: PMC8248224 DOI: 10.1259/bjr.20210211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aorto-ostial coronary lesions (AOLs) are important to detect due to the high risk of catastrophic consequences. Unfortunately, due to the complexities of these lesions, they may be missed on invasive coronary angiography. Computed tomography coronary angiogram (CTCA) is highly sensitive and specific in detecting AOLs, and has the additional advantage of demonstrating the surrounding anatomy. CTCA is particularly useful when assessing for AOL aetiologies in addition to atherosclerotic disease, e.g.Congenital anomalies, extrinsic Compression, Iatrogenic, Arteritis and Other, such as Thrombus, Embolism, Dissection and Spasm. This gives rise to “CIAO (TEDS)” as a proposed aide-mémoire and will form the structure of this pictorial review.
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Affiliation(s)
- Jan Y J Riley
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Kai'En Leong
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ben Ariff
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Radiology, Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Zuin M, Rigatelli G, Vassilev D, Ronco F, Rigatelli A, Roncon L. Computational fluid dynamic-derived wall shear stress of non-significant left main bifurcation disease may predict acute vessel thrombosis at 3-year follow-up. Heart Vessels 2020; 35:297-306. [PMID: 31482218 DOI: 10.1007/s00380-019-01494-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023]
Abstract
Wall shear stress (WSS) plays a pivotal role on plaque progression in coronary artery disease. We assess the prognostic role of baseline mean WSS in developing a bifurcation-located myocardial infarction (B-MI) over the following 3 years in angiographically non-significant LM bifurcation disease. For this purpose, we retrospectively reviewed the procedural and medical records of consecutive patients evaluated in our center from 1st January 2014 to 1st January 2019 who had a non-significant LM bifurcation disease as evaluated at coronary computed tomography angiography (CCTA) and confirmed by coronary angiography. Each bifurcation model was reconstructed on the patient-specific geometries derived from the CCTA. The population was divided into two groups: patients with (n = 12) and without B-MI (n = 20) over the following 3 years. Both the mean WSSprox of each branch and the WSSentire_lesion of each vessel, adjusted for the respective mean lesions lengths and 3-dimensional percentage of stenosis (DS%), resulted in independent predictors of 3-year B-MI. Multivariate Cox-regression analysis confirmed that a baseline mean WSSentire_model ≥ 5.05 Pa (HR 1.98, 95% CI 1.83-2.10, p = 0.001) was a predictor of 3-year B-MI independently from the entire mean lesions lengths (HR 1.56. 95% CI 1.43.1.68, p = 0.002) and DS% (HR 1.26, 95% CI 1.18-1.37, p = 0.03). In conclusion, in patients with angiographically non-significant LM bifurcation disease, both the mean WSSprox of each branch and WSSentire_lesion of each stenotic vessel predicted the occurrence of B-MI over the following 3 years. Moreover, the WSSentire_bifurcation ≥ 5.05 Pa seems to be a predictor of 3-year B-MI independently from the DS% and lesions lengths.
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Affiliation(s)
- Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria Della Misericordia Hospital, Viale Tre Martiri, 45100, Rovigo, Italy.
| | - Dobrin Vassilev
- "Alexandrovska" University Hospital, Medical University, Sofia, Bulgaria
| | - Federico Ronco
- Interventional Cardiology, Cardiology Department, Mestre General Hospital, Mestre, Italy
| | - Alberto Rigatelli
- Department of Emergency, Borgo Trento University Hospital, Verona, Italy
| | - Loris Roncon
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
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Mahmood M, Altaf A, Salahuddin M, Khan M, Shah KA, Shah H. Prognosis of Percutaneous Intervention of a Left Main Coronary Artery Stenosis Without the Use of Intravascular Imaging. Cureus 2018; 10:e2857. [PMID: 30148010 PMCID: PMC6107041 DOI: 10.7759/cureus.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this study was to assess the prognosis in patients with left main coronary artery stenosis one year after percutaneous coronary intervention (PCI). Methods Our study included 40 patients who underwent PCI for left main coronary artery stenosis without the use of intravascular ultrasound (IVUS). Patients were followed for a year, and the prognostic effect of PCI on a composite end-point of revascularization, new myocardial infarction, cardiac death, and on all-cause mortality was assessed in multivariable Cox analysis. Results The multivariable analysis showed a good prognosis in patients receiving PCI with a total event rate of 7.5%. The independent predictors for major adverse cardiac events (MACE) were diabetes (p = 0.02). Other prognostic factors included in the model were gender, age, smoking, body mass index (BMI), hypertension, the complexity of the vessel, and ejection fraction. Conclusion PCI for left main coronary artery stenosis without the use of IVUS has a good prognosis after one year of clinical follow-up.
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Affiliation(s)
- Mazhar Mahmood
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Afrasyab Altaf
- Cardiology, Tongji Hospital of Tongji University, Shanghai, CHN
| | - Momin Salahuddin
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Momin Khan
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Karamat A Shah
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Hammad Shah
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
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Srinivas SK, Sunil B, Bhat P, Manjunath CN. Incidence, predictors, clinical profile, management and outcome of patients with isolated left main coronary artery ostial disease. Indian Heart J 2018; 70:214-219. [PMID: 29716697 PMCID: PMC5993923 DOI: 10.1016/j.ihj.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 06/05/2017] [Accepted: 06/14/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives Isolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease. Methods 15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients. Results The mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234). Conclusion In one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.
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Affiliation(s)
- Sunil Kumar Srinivas
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
| | - Bharathi Sunil
- Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
| | - Prabhavathi Bhat
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
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Huo Y, Kassab GS. Scaling laws of coronary circulation in health and disease. J Biomech 2016; 49:2531-9. [DOI: 10.1016/j.jbiomech.2016.01.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/28/2016] [Indexed: 02/07/2023]
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Intravascular ultrasound comparison of left main coronary artery disease between white and Asian patients. Am J Cardiol 2013; 111:979-84. [PMID: 23340034 DOI: 10.1016/j.amjcard.2012.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 11/24/2022]
Abstract
We assessed the ethnic differences in coronary atherosclerosis lesion morphology between white and Asian patients. Our hypothesis was that left main coronary artery (LMCA) disease was more focal and less complex in Asian than in Western white patients. We studied 99 Asian patients (Japan and South Korea) and 99 matched control United States white patients with a stable clinical presentation and >30% LMCA angiographic diameter stenosis by visual estimation. The matching parameters included age, gender, and diabetes mellitus. The vessel and lumen areas and calcium arc were analyzed every 0.5 mm and normalized for analysis length. Overall, 75.1% of the patients were men and 34.1% had diabetes. The patient age was 68.0 ± 10 years, with no differences between the Asian and white patients. The Asian patients had a lower prevalence of hyperlipidemia than the white patients (41.4% vs 81.8%; p <0.0001) and were smaller in size, and the white patients were more obese (body mass index 23.7 ± 2.6 vs 27.6 ± 4.1 kg/m(2), p <0.0001). The Asian patients had a smaller lumen area (5.2 ± 1.8 vs 6.2 ± 14 mm(2); p <0.0001), larger vessel area (20.0 ± 4.9 vs 18.4 ± 4.4 mm(2); p <0.0001), and larger plaque burden (72 ± 10 vs 64 ± 12%: p <0.0001) at the minimum lumen site and over the entire LMCA length. The white patients had more calcification, whether assessed by the maximum arc (82° ± 74° vs 49° ± 45°; p <0.0001) or total length (3.6 ± 3.2 vs 2.1 ± 2.1 mm; p <0.0001). In conclusion, after matching well-known risk factors, there appeared to be ethnic differences in coronary atherosclerosis morphology between Asian and white patients, at least as it affected LMCA morphology.
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Huo Y, Choy JS, Wischgoll T, Luo T, Teague SD, Bhatt DL, Kassab GS. Computed tomography-based diagnosis of diffuse compensatory enlargement of coronary arteries using scaling power laws. J R Soc Interface 2013; 10:20121015. [PMID: 23365197 DOI: 10.1098/rsif.2012.1015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Glagov's positive remodelling in the early stages of coronary atherosclerosis often results in plaque rupture and acute events. Because positive remodelling is generally diffused along the epicardial coronary arterial tree, it is difficult to diagnose non-invasively. Hence, the objective of the study is to assess the use of scaling power law for the diagnosis of positive remodelling of coronary arteries based on computed tomography (CT) images. Epicardial coronary arterial trees were reconstructed from CT scans of six Ossabaw pigs fed on a high-fat, high-cholesterol, atherogenic diet for eight months as well as the same number of body-weight-matched farm pigs fed on a lean chow (101.9±16.1 versus 91.5±13.1 kg). The high-fat diet Ossabaw pig model showed diffuse positive remodelling of epicardial coronary arteries. Good fit of measured coronary data to the length-volume scaling power law ( where L(c) and V(c) are crown length and volume) were found for both the high-fat and control groups (R(2) = 0.95±0.04 and 0.99±0.01, respectively). The coefficient, K(LV), decreased significantly in the high-fat diet group when compared with the control (14.6±2.6 versus 40.9±5.6). The flow-length scaling power law, however, was nearly unaffected by the positive remodelling. The length-volume and flow-length scaling power laws were preserved in epicardial coronary arterial trees after positive remodelling. K(LV) < 18 in the length-volume scaling relation is a good index of positive remodelling of coronary arteries. These findings provide a clinical rationale for simple, accurate and non-invasive diagnosis of positive remodelling of coronary arteries, using conventional CT scans.
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Affiliation(s)
- Yunlong Huo
- Biomedical Engineering, Indiana University Purdue University Indianapolis, IN, USA
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Molina JE. 10 plus-years follow-up after patch angioplasty of the left main coronary artery. Int J Angiol 2012; 20:143-8. [PMID: 22942629 DOI: 10.1055/s-0031-1283217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
In ostial or proximal left main coronary artery (LMCA) obstruction, re-establishment of normal antegrade flow via the main trunk may be preferable to distal bypass grafting. The objective of this study was to assess the effectiveness of patch plasty of the left main (LM) trunk of the coronary artery for more than 10 years. Direct widening of the LMCA was recommended to patients with ostial, proximal, or midpoint stenosis of the main trunk. Group I of 16 patients had isolated LM obstruction with no distal disease, and Group II of 15 patients had, in addition, right coronary obstruction. The mean age was 60.9 years (age group, 47 to 83 years). Nineteen patients underwent this operation through an anterior transverse aortotomy. No endarterectomies were performed. In Group II, in addition, a single saphenous vein bypass graft was placed in the right coronary artery. There were no operative deaths. Follow-up period extends from 10 to 18 years (mean 11.2). Eight patients had angiography from 3 to 9 years after surgery and all show adequate LM trunk caliber. Noncardiac deaths occured in five patients (26.3%) at 2 months, and 1, 4, 6, and 7 years after surgery. Two women with isolated ostial stenosis diagnosed as a spasm have not shown progression of coronary disease 7 to 9 years after the operation. Widening of the LMCA should be considered in selective cases, only when ostial, proximal, or midportion stenosis of the main vessel exist, even if a right coronary bypass graft is required.
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Affiliation(s)
- J Ernesto Molina
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Medical School, Minneapolis, MN
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Abstract
For several decades of medical history, coronary-artery bypass grafting (CABG) has been regarded as the best treatment option for patients with unprotected left main coronary artery (LMCA) disease, considering lesion priority and its clinical consequences. Over the time, with remarkable advancements in techniques of percutaneous coronary intervention (PCI), supporting devices, and adjunctive pharmacologic therapy, PCI with DES implantation has appeared to be new and alternative option for optimal revascularization therapy for these patients. The available cumulative evidence suggests that the safety outcomes such as mortality or composite of death, myocardial infarction and stroke are similar among PCI and CABG for patients with LMCA disease, the only difference was the rate of repeat revascularization. Current evidence and ongoing large clinical trials may encourage interventional cardiologists to choose PCI with stenting as an alternative revascularization strategy for unprotected LMCA disease in future. Finally, this evidence will change the current clinical practice and the guideline of optimal revascularization strategy for unprotected LMCA disease.
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Affiliation(s)
- Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea,
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Park SJ, Park DW. Treatment of patients with left main coronary artery disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 14:108-16. [PMID: 22134853 DOI: 10.1007/s11936-011-0159-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OPINION STATEMENT Considering lesion priority and its clinical consequences, coronary artery bypass grafting (CABG) has been a treatment of choice for revascularization in patients with significant left main coronary artery (LMCA) disease, However, with remarkable advancements in techniques of percutaneous coronary intervention (PCI), supporting devices, and adjunctive pharmacologic therapy, PCI with stenting has emerged to be a less invasive and feasible revascularization treatment for these patients. The cumulative evidence suggests that the safety outcomes such as mortality or composite of death, myocardial infarction, and stroke are similar among PCI and CABG, with the only difference being the rate of repeat revascularization. Based on these data, the current guideline of revascularization of LMCA disease has adopted an increasing off-label experience with stenting and clinical studies and been updated to partly approve PCI as a viable alternative (in level of class IIb) in selected patients. The choice of PCI or CABG for unprotected LMCA disease depends on several clinical and anatomic features, ensuring crucial patient selection to be a cornerstone for achieving favorable long-term outcomes. In patients with very complex anatomic features and concomitant diffuse multivessel disease, CABG is preferred so as to avoid procedural and future thrombotic risks and to provide more complete revascularization. By contrast, in patients with relatively simple LMCA disease, such as ostial/shaft LMCA disease, isolated LMCA disease (with or without one or two-vessel involvement), and LMCA disease with low SYNTAX score, PCI is an alternative, and in some cases a preferred, strategy to reduce surgical risks (eg, stroke and in-hospital events following major surgery). For the future, ongoing large clinical trials might also boost interventional cardiologists to select PCI with stenting as an alternative revascularization strategy for unprotected LMCA disease. This evidence will most likely change the current clinical practice and guidelines of optimal revascularization strategy for unprotected LMCA disease.
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Affiliation(s)
- Seung-Jung Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea,
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Kolovou G, Vasiliadis I, Kolovou V, Karakosta A, Mavrogeni S, Papadopoulou E, Papamentzelopoulos S, Giannakopoulou V, Marvaki A, Degiannis D, Bilianou H. The role of common variants of the cholesteryl ester transfer protein gene in left main coronary artery disease. Lipids Health Dis 2011; 10:156. [PMID: 21899732 PMCID: PMC3175181 DOI: 10.1186/1476-511x-10-156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cholesteryl ester transfer protein (CETP) has a central role in the lipid metabolism and therefore may alter the susceptibility to atherosclerosis. METHODS The DNA of 471 subjects [133 subjects with angiographically documented left main coronary artery disease (LMCAD), 241 subjects with more peripheral coronary artery disease (MPCAD) and 97 subjects self reported healthy (Controls)] was analyzed for the frequency of TaqIB and I405V polymorphisms in the gene coding CETP. RESULTS There is no significant difference in CETP allele frequency or genotype distribution among LMCAD and MPCAD patients although there is statistical difference between LMCAD and Controls (p = 0.001). Specifically, patients with LMCAD and B1B1 genotype of TaqIB polymorphism were more frequent present compared to Controls (33.8% vs 22.9%, respectively). The frequency of B2B2 genotype was 3 times lower in the LMCAD group compared to Controls (10.5% vs 30.2%, respectively). In the LMCAD group the frequency of B1 allele compared to Controls was higher (62% vs 46%, respectively, p = 0.001). The relationship between TaqIB gene polymorphism and the LMCAD was independent of lipid profile, with the exception of apolipoprotein A. CONCLUSIONS These findings indicate that the TaqIB polymorphism may have potential importance in screening individuals at high risk for developing CAD. However, this polymorphism cannot distinguish between LMCAD and MPCAD. Further prospective investigations in larger populations are required to confirm these findings.
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Affiliation(s)
- Genovefa Kolovou
- 1st Cardiology Department, Onassis Cardiac Surgery Center 356, Sygrou Ave,, 176 74 Athens, Greece.
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Management of left main coronary disease. Eur J Cardiothorac Surg 2011; 40:1274-5; author reply 1275. [PMID: 21450485 DOI: 10.1016/j.ejcts.2011.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 12/13/2010] [Accepted: 02/16/2011] [Indexed: 11/24/2022] Open
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Sachithanandan A, Badmanaban B. Why coronary artery bypass surgery is still the optimal treatment strategy for left main stem disease: an evidence-based review with a Malaysian surgical perspective. HEART ASIA 2011; 3:126-9. [PMID: 27326010 DOI: 10.1136/heartasia-2011-010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Accepted: 09/06/2011] [Indexed: 11/04/2022]
Affiliation(s)
| | - Balaji Badmanaban
- Department of Cardiothoracic Surgery, Hospital Serdang, Selangor, Malaysia
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