International Journal of Cardiovascular Sciences. 29/set/2020;33(5):565-71.
Controversies in the Indications of Percutaneous Angioplasty Or Coronary Artery Bypass Grafting In The Treatment Of Left Main Disease
Renato A. K. Kalil
, Roberto T. Sant´Anna
, Felipe Borsu de Salles
Resumo Gráfico
Introduction
Left main coronary artery (LMCA) disease is a high-risk clinical situation, since this artery is responsible for the irrigation of more than two-thirds of the myocardial tissue, LMCA disease is associated with increased risk of adverse cardiac events. Traditionally, the gold standard of treatment for significant LMCA disase, understood as a stenosis> 50%, is coronary artery bypass grafting (CABG) surgery. –
The technological evolution of percutaneous treatment and its safe application for LMCA disease in the PRECOMBAT study made it a viable alternative, initially restricted to patients at high surgical risk and with LMCA disease confined to the proximal portion of the trunk. Subsequent studies have suggested the equivalence of percutaneous coronary intervention (PCI) and CABG in low and moderate complexity LMCA disease, which was reflected in the most recent guidelines ( ). Clinical registries, with real-patient outcomes, – and long-term results from the EXCEL study, contest this notion of equivalence between therapies in terms of mortality. The study was controversial, especially regarding the definition of clinical outcomes.
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