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Int J Angiol 2021; 30(03): 194-201
DOI: 10.1055/s-0041-1730446
Review Article

Left Main Coronary Artery Disease in Diabetics: Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting?

Logan Disney 
1   University of Kentucky College of Medicine, Lexington, Kentucky
,
Chandrashekhar Ramaiah 
2   Department of Cardiac Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee
,
Meghna Ramaiah
3   University of Chicago, Chicago, Illinois
,
Suresh Keshavamurthy 
4   Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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Abstract

The choice between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for myocardial revascularization in patients with left main disease (LMD) is controversial. There is general agreement that CABG is appropriate for all patients, and PCI is acceptable for those with low-to-intermediate anatomic complexity. However, there is uncertainty about the relative safety and efficacy of PCI in patients with more complex LMD and with comorbidities such as diabetes. No direct comparison trial has focused on revascularization in diabetic patients with LMD, and thus conclusions on the topic are subject to the limitations of subgroup analysis, as well as the heterogeneous exclusion criteria, and methodologies of individual trials. The available evidence suggests that among diabetics, CABG is superior in patients with LMD with SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and dardiac surgery) score greater than 33, distal bifurcation disease, or multivessel disease. PCI may be appropriate in those with less-extensive disease or those with limited life expectancy or high surgical risk.

Keywords

left main coronary artery disease - cardiac surgery - cardiovascular risk factors - PCI - coronary intervention - insulin resistance - coronary artery


Publikationsverlauf

Artikel online veröffentlicht:
31. August 2021

© 2021. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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