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Left main coronary artery disease

MedGen UID:
721292
•Concept ID:
C1299433
•
Disease or Syndrome
Synonyms: Left Main Coronary Artery Disease; Left Main Coronary Disease; Left Main Disease; Left Main Diseases
SNOMED CT: Left main coronary artery disease (371804009)

Professional guidelines

PubMed

Management of Left Main Coronary Artery Disease.
Ramadan R, Boden WE, Kinlay S
J Am Heart Assoc 2018 Mar 31;7(7) doi: 10.1161/JAHA.117.008151. PMID: 29605817Free PMC Article
Left main coronary artery disease: pathophysiology, diagnosis, and treatment.
Collet C, Capodanno D, Onuma Y, Banning A, Stone GW, Taggart DP, Sabik J, Serruys PW
Nat Rev Cardiol 2018 Jun;15(6):321-331. doi: 10.1038/s41569-018-0001-4. PMID: 29599504
Left main coronary artery disease: importance, diagnosis, assessment, and management.
Ragosta M
Curr Probl Cardiol 2015 Mar;40(3):93-126. Epub 2014 Nov 14 doi: 10.1016/j.cpcardiol.2014.11.003. PMID: 25765453

Recent clinical studies

Etiology

Left Main Disease.
Lee J, Park DW, Park SJ
Interv Cardiol Clin 2022 Oct;11(4):359-371. Epub 2022 Sep 24 doi: 10.1016/j.iccl.2022.02.006. PMID: 36243482
Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis.
Sabatine MS, Bergmark BA, Murphy SA, O'Gara PT, Smith PK, Serruys PW, Kappetein AP, Park SJ, Park DW, Christiansen EH, Holm NR, Nielsen PH, Stone GW, Sabik JF, Braunwald E
Lancet 2021 Dec 18;398(10318):2247-2257. Epub 2021 Nov 15 doi: 10.1016/S0140-6736(21)02334-5. PMID: 34793745
Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial.
Holm NR, Mäkikallio T, Lindsay MM, Spence MS, Erglis A, Menown IBA, Trovik T, Kellerth T, Kalinauskas G, Mogensen LJH, Nielsen PH, Niemelä M, Lassen JF, Oldroyd K, Berg G, Stradins P, Walsh SJ, Graham ANJ, Endresen PC, Fröbert O, Trivedi U, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH; NOBLE investigators
Lancet 2020 Jan 18;395(10219):191-199. Epub 2019 Dec 23 doi: 10.1016/S0140-6736(19)32972-1. PMID: 31879028
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Thuijs DJFM, Kappetein AP, Serruys PW, Mohr FW, Morice MC, Mack MJ, Holmes DR Jr, Curzen N, Davierwala P, Noack T, Milojevic M, Dawkins KD, da Costa BR, Jüni P, Head SJ; SYNTAX Extended Survival Investigators
Lancet 2019 Oct 12;394(10206):1325-1334. Epub 2019 Sep 2 doi: 10.1016/S0140-6736(19)31997-X. PMID: 31488373
Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW; SYNTAX Investigators
N Engl J Med 2009 Mar 5;360(10):961-72. Epub 2009 Feb 18 doi: 10.1056/NEJMoa0804626. PMID: 19228612

Diagnosis

A Practical Approach to Left Main Coronary Artery Disease: JACC State-of-the-Art Review.
Davidson LJ, Cleveland JC, Welt FG, Anwaruddin S, Bonow RO, Firstenberg MS, Gaudino MF, Gersh BJ, Grubb KJ, Kirtane AJ, Tamis-Holland JE, Truesdell AG, Windecker S, Taha RA, Malaisrie SC
J Am Coll Cardiol 2022 Nov 29;80(22):2119-2134. doi: 10.1016/j.jacc.2022.09.034. PMID: 36423996
Left main coronary artery disease: pathophysiology, diagnosis, and treatment.
Collet C, Capodanno D, Onuma Y, Banning A, Stone GW, Taggart DP, Sabik J, Serruys PW
Nat Rev Cardiol 2018 Jun;15(6):321-331. doi: 10.1038/s41569-018-0001-4. PMID: 29599504
Physiological assessment of left main coronary artery disease.
Modi BN, van de Hoef TP, Piek JJ, Perera D
EuroIntervention 2017 Sep 20;13(7):820-827. doi: 10.4244/EIJ-D-17-00135. PMID: 28606883
Left main coronary artery disease: importance, diagnosis, assessment, and management.
Ragosta M
Curr Probl Cardiol 2015 Mar;40(3):93-126. Epub 2014 Nov 14 doi: 10.1016/j.cpcardiol.2014.11.003. PMID: 25765453
Left main coronary artery disease: importance, diagnosis, assessment and management. Foreword.
Rahimtoola SH
Curr Probl Cardiol 2015 Mar;40(3):91. Epub 2014 Nov 13 doi: 10.1016/j.cpcardiol.2014.11.004. PMID: 25765452

Therapy

PCI or CABG for left main coronary artery disease: the SWEDEHEART registry.
Persson J, Yan J, Angerås O, Venetsanos D, Jeppsson A, Sjögren I, Linder R, Erlinge D, Ivert T, Omerovic E
Eur Heart J 2023 Aug 7;44(30):2833-2842. doi: 10.1093/eurheartj/ehad369. PMID: 37288564Free PMC Article
A Practical Approach to Left Main Coronary Artery Disease: JACC State-of-the-Art Review.
Davidson LJ, Cleveland JC, Welt FG, Anwaruddin S, Bonow RO, Firstenberg MS, Gaudino MF, Gersh BJ, Grubb KJ, Kirtane AJ, Tamis-Holland JE, Truesdell AG, Windecker S, Taha RA, Malaisrie SC
J Am Coll Cardiol 2022 Nov 29;80(22):2119-2134. doi: 10.1016/j.jacc.2022.09.034. PMID: 36423996
Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis.
Sabatine MS, Bergmark BA, Murphy SA, O'Gara PT, Smith PK, Serruys PW, Kappetein AP, Park SJ, Park DW, Christiansen EH, Holm NR, Nielsen PH, Stone GW, Sabik JF, Braunwald E
Lancet 2021 Dec 18;398(10318):2247-2257. Epub 2021 Nov 15 doi: 10.1016/S0140-6736(21)02334-5. PMID: 34793745
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Thuijs DJFM, Kappetein AP, Serruys PW, Mohr FW, Morice MC, Mack MJ, Holmes DR Jr, Curzen N, Davierwala P, Noack T, Milojevic M, Dawkins KD, da Costa BR, Jüni P, Head SJ; SYNTAX Extended Survival Investigators
Lancet 2019 Oct 12;394(10206):1325-1334. Epub 2019 Sep 2 doi: 10.1016/S0140-6736(19)31997-X. PMID: 31488373
Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.
Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Mäkikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez AE, Sabik JF 3rd, Stables RH, Stone GW, Serruys PW, Kappetein AP
Lancet 2018 Mar 10;391(10124):939-948. Epub 2018 Feb 23 doi: 10.1016/S0140-6736(18)30423-9. PMID: 29478841

Prognosis

Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial.
Holm NR, Mäkikallio T, Lindsay MM, Spence MS, Erglis A, Menown IBA, Trovik T, Kellerth T, Kalinauskas G, Mogensen LJH, Nielsen PH, Niemelä M, Lassen JF, Oldroyd K, Berg G, Stradins P, Walsh SJ, Graham ANJ, Endresen PC, Fröbert O, Trivedi U, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH; NOBLE investigators
Lancet 2020 Jan 18;395(10219):191-199. Epub 2019 Dec 23 doi: 10.1016/S0140-6736(19)32972-1. PMID: 31879028
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Thuijs DJFM, Kappetein AP, Serruys PW, Mohr FW, Morice MC, Mack MJ, Holmes DR Jr, Curzen N, Davierwala P, Noack T, Milojevic M, Dawkins KD, da Costa BR, Jüni P, Head SJ; SYNTAX Extended Survival Investigators
Lancet 2019 Oct 12;394(10206):1325-1334. Epub 2019 Sep 2 doi: 10.1016/S0140-6736(19)31997-X. PMID: 31488373
Left main coronary artery disease: pathophysiology, diagnosis, and treatment.
Collet C, Capodanno D, Onuma Y, Banning A, Stone GW, Taggart DP, Sabik J, Serruys PW
Nat Rev Cardiol 2018 Jun;15(6):321-331. doi: 10.1038/s41569-018-0001-4. PMID: 29599504
Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.
Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Mäkikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez AE, Sabik JF 3rd, Stables RH, Stone GW, Serruys PW, Kappetein AP
Lancet 2018 Mar 10;391(10124):939-948. Epub 2018 Feb 23 doi: 10.1016/S0140-6736(18)30423-9. PMID: 29478841
A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study.
O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M
Circulation 2012 Oct 2;126(14):1717-27. Epub 2012 Aug 30 doi: 10.1161/CIRCULATIONAHA.112.098194. PMID: 22935569

Clinical prediction guides

PCI or CABG for left main coronary artery disease: the SWEDEHEART registry.
Persson J, Yan J, Angerås O, Venetsanos D, Jeppsson A, Sjögren I, Linder R, Erlinge D, Ivert T, Omerovic E
Eur Heart J 2023 Aug 7;44(30):2833-2842. doi: 10.1093/eurheartj/ehad369. PMID: 37288564Free PMC Article
Percutaneous Coronary Intervention vs Coronary Artery Bypass Graft Surgery for Left Main Disease in Patients With and Without Acute Coronary Syndromes: A Pooled Analysis of 4 Randomized Clinical Trials.
Gaba P, Christiansen EH, Nielsen PH, Murphy SA, O'Gara PT, Smith PK, Serruys PW, Kappetein AP, Park SJ, Park DW, Stone GW, Sabik JF, Sabatine MS, Holm NR, Bergmark BA
JAMA Cardiol 2023 Jul 1;8(7):631-639. doi: 10.1001/jamacardio.2023.1177. PMID: 37256598Free PMC Article
Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis.
Sabatine MS, Bergmark BA, Murphy SA, O'Gara PT, Smith PK, Serruys PW, Kappetein AP, Park SJ, Park DW, Christiansen EH, Holm NR, Nielsen PH, Stone GW, Sabik JF, Braunwald E
Lancet 2021 Dec 18;398(10318):2247-2257. Epub 2021 Nov 15 doi: 10.1016/S0140-6736(21)02334-5. PMID: 34793745
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Thuijs DJFM, Kappetein AP, Serruys PW, Mohr FW, Morice MC, Mack MJ, Holmes DR Jr, Curzen N, Davierwala P, Noack T, Milojevic M, Dawkins KD, da Costa BR, Jüni P, Head SJ; SYNTAX Extended Survival Investigators
Lancet 2019 Oct 12;394(10206):1325-1334. Epub 2019 Sep 2 doi: 10.1016/S0140-6736(19)31997-X. PMID: 31488373
Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.
Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Mäkikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez AE, Sabik JF 3rd, Stables RH, Stone GW, Serruys PW, Kappetein AP
Lancet 2018 Mar 10;391(10124):939-948. Epub 2018 Feb 23 doi: 10.1016/S0140-6736(18)30423-9. PMID: 29478841

Recent systematic reviews

Ten-year outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for multivessel or left main coronary artery disease: a systematic review and meta-analysis.
Feng S, Li M, Fei J, Dong A, Zhang W, Fu Y, Zhao Y
J Cardiothorac Surg 2023 Feb 2;18(1):54. doi: 10.1186/s13019-023-02101-y. PMID: 36732810Free PMC Article
Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis.
Ullah W, Sattar Y, Ullah I, Susheela A, Mukhtar M, Alraies MC, Mamas MA, Fischman DL
J Interv Cardiol 2020;2020:4081642. Epub 2020 Jul 26 doi: 10.1155/2020/4081642. PMID: 32774183Free PMC Article
Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.
Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Mäkikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez AE, Sabik JF 3rd, Stables RH, Stone GW, Serruys PW, Kappetein AP
Lancet 2018 Mar 10;391(10124):939-948. Epub 2018 Feb 23 doi: 10.1016/S0140-6736(18)30423-9. PMID: 29478841
Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta-analysis of randomized controlled trials.
Sharma SP, Dahal K, Khatra J, Rosenfeld A, Lee J
Cardiovasc Ther 2017 Jun;35(3) doi: 10.1111/1755-5922.12260. PMID: 28371437
Coronary revascularization in diabetic patients: a systematic review and Bayesian network meta-analysis.
Tu B, Rich B, Labos C, Brophy JM
Ann Intern Med 2014 Nov 18;161(10):724-32. doi: 10.7326/M14-0808. PMID: 25402514

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