2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG

被引:26
作者
Byrne, Robert A. [1 ,2 ,3 ]
Fremes, Stephen [4 ,5 ]
Capodanno, Davide [6 ]
Czerny, Martin [7 ,8 ]
Doenst, Torsten [9 ]
Emberson, Jonathan R. [10 ]
Falk, Volkmar [11 ,12 ,13 ,14 ]
Gaudino, Mario [15 ]
Mcmurray, John J., V [16 ]
Mehran, Roxana [17 ]
Milojevic, Milan [18 ,19 ]
Uva, Miguel Sousa [20 ,21 ]
机构
[1] Mater Private Network, Dept Cardiol, 73 Eccles St, Dublin D07 KWR1, Ireland
[2] Mater Private Network, Cardiovasc Res Inst CVRI Dublin, 73 Eccles St, Dublin D07 KWR1, Ireland
[3] RCSI Univ Med & Hlth Sci, Sch Pharm & Biomol Sci, 123 St Stephens Green, Dublin D02 YN77, Ireland
[4] Sunnybrook Hlth Sci Ctr, Schulich Heart Program, Div Cardiac Surg, 2075 Bayview Ave,Suite H405, Toronto, ON M4N 3M5, Canada
[5] Univ Toronto, Dept Surg, Toronto, ON, Canada
[6] Univ Catania, Cardiothorac Vasc & Transplant Dept, Azienda Osped Univ Policlin Gaspare Rodol San Marc, Catania, Italy
[7] Univ Heart Ctr Freiburg, Clin Cardiovasc Surg, Bad Krozingen, Germany
[8] Albert Ludwigs Univ Freiburg, Fac Med, Freiburg, Germany
[9] Friedrich Schiller Univ Jena, Univ Hosp Jena, Dept Cardiothorac Surg, Jena, Germany
[10] Univ Oxford, Med Res Council Populat Hlth Res Unit, Nuffield Dept Populat Hlth, Oxford, England
[11] Deutsch Herzzentrum Berlin, Dept Cardiothorac & Vasc Surg, Berlin, Germany
[12] Charite Univ Med Berlin, Dept Cardiovasc Surg, Berlin, Germany
[13] DZHK, German Ctr Cardiovasc Res, Partner Site Berlin, Berlin, Germany
[14] Swiss Fed Inst Technol, Dept Hlth Sci & Technol, Zurich, Switzerland
[15] Weill Cornell Med, Dept Cardiothorac Surg, New York, NY USA
[16] Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Scotland
[17] Icahn Sch Med Mt Sinai, New York, NY USA
[18] Dedinje Cardiovasc Inst, Dept Cardiac Surg & Cardiovasc Res, Belgrade, Serbia
[19] Erasmus MC, Dept Cardiothorac Surg, Rotterdam, Netherlands
[20] Hosp Santa Cruz, Dept Cardiac Surg, Carnaxide, Portugal
[21] Univ Porto, Med Sch, Dept Physiol & Cardiac Surg, Porto, Portugal
基金
英国医学研究理事会;
关键词
Coronary artery disease; clinical practice guidelines; coronary artery bypass grafting; Heart Team; left main coronary artery; left main stenosis; meta-analysis; myocardial revascularization; percutaneous coronary intervention; randomized controlled trials; PROCEDURAL MYOCARDIAL-INFARCTION; EVEROLIMUS-ELUTING STENTS; SYNTAX SCORE II; QUALITY-OF-LIFE; INTRAVASCULAR ULTRASOUND; BYPASS-SURGERY; DECISION-MAKING; 5-YEAR OUTCOMES; INTERVENTION; HEART;
D O I
10.1093/ejcts/ezad286
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0-32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality.
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页数:12
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