Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 80(22), 2119–2134. https://doi.org/10.1016/j.jacc.2022.09.034 Dr. Laura Davidson et al
Points
- The best proof that angioplasty improves longevity above therapeutic treatment alone in normal patients is seen in the left main coronary artery disease, a subtype of coronary artery disease. However, the left main coronary artery disease therapy that works best necessitates difficult and quick decisions.
- Current clinical practice standards offer doctors direction, but it can still be challenging to decide on a type of therapy for a specific patient.
Summary
The Cardiac Surgery Team and Interventional Council of the American College of Cardiology created a realistic strategy for treating left main coronary artery disease based on randomized medical testing, meta-analyses, and medical practice recommendations.
An intervention protocol with medical management alone or in collaboration with percutaneous coronary intervention is recommended in recognition of the intricacy of left main coronary artery disease, which seldom manifests alone and is frequently in combination with multivessel disease. Ostial and distal lesions are the two types of left main coronary artery disease, and multivessel disease may exacerbate these symptoms.
For people who have left main coronary artery disease, the route of angioplasty should be chosen after considering medical, methodological, and organizational variables. Ad hoc treatment in individuals having steady illness and complaints is explicitly prohibited.
It is advised to use a cardiac team approach with the collective decision that considers therapeutic, operational, and institutional factors and accommodates each participant’s preferences, demands, and particular medical circumstances.
Type 2 diabetes, complicated multivessel illness, substantial left ventricular systolic dysfunction, concurrent valvular pathology, reoccurring previous transcatheter malfunction, anatomical variables making total revascularization with Percutaneous coronary intervention, and exclusion criteria to double antibiotic therapy are some variables that may favor coronary artery bypass grafting for left main coronary artery disease.
Notable disruptive lung disorder, older age, medical debilitation, chronic chest deformation, porcelain aorta, aftereffects of previous chest radiation, inadequate surgery passageways or bypass objectives, obstacles to postoperative rehabilitation, or respiratory arrest are all variables that may favor Percutaneous coronary intervention for left main coronary artery disease.
Increased prevalence of severe comorbidities, extreme weakness, short lifespan, and educated clinical judgment are all indicators that may encourage conventional treatment for left main coronary artery disease.
It must be noted that the ideal reperfusion plan for a specific person might change depending on the qualifications, track record, and results of certain surgeries and medical specialists at a certain hospital.
Link to the article: https://www.jacc.org/doi/10.1016/j.jacc.2022.09.034
References Davidson, L. J., Cleveland, J. C., Welt, F. G., Anwaruddin, S., Bonow, R. O., Firstenberg, M. S., Gaudino, M. F., Gersh, B. J., Grubb, K. J., Kirtane, A. J., Tamis-Holland, J. E., Truesdell, A. G., Windecker, S., Taha, R. A., & Malaisrie, S. C. (2022). A practical approach to left main coronary artery disease. Journal of the American College of Cardiology, 80(22), 2119–2134. https://doi.org/10.1016/j.jacc.2022.09.034
