Left Main Coronary Artery Disease: Importance, Diagnosis, Assessment, and Management
Abstract Left main coronary disease is seen in 4%-6% of patients undergoing coronary angiography for an ischemic evaluation and is a potentially fatal condition if not promptly identified and treated. Recent studies have increased our understanding of the complexity of left main coronary artery dise...
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| Veröffentlicht in: | Current problems in cardiology 2015-03, Vol.40 (3), p.93-126 |
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| creator | Ragosta, Michael, MD |
| description | Abstract Left main coronary disease is seen in 4%-6% of patients undergoing coronary angiography for an ischemic evaluation and is a potentially fatal condition if not promptly identified and treated. Recent studies have increased our understanding of the complexity of left main coronary artery disease. This lesion subset offers numerous challenges in diagnosis and management. Fractional flow reserve and intravascular ultrasound are important adjuncts to angiography to determine the significance of ambiguous lesions of the left main coronary artery. Surgery is associated with much better outcomes than medical therapy and is considered by many to be the standard of care in patients who are surgical candidates. Recent studies comparing surgery with percutaneous coronary intervention (PCI) have defined subgroups with lesser extent of disease burden that may do just as well with PCI. Challenges remain in the management of bifurcation disease, and the interventional community anxiously awaits the results of the large-scale randomized trials comparing PCI with surgery. |
| doi_str_mv | 10.1016/j.cpcardiol.2014.11.003 |
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Recent studies have increased our understanding of the complexity of left main coronary artery disease. This lesion subset offers numerous challenges in diagnosis and management. Fractional flow reserve and intravascular ultrasound are important adjuncts to angiography to determine the significance of ambiguous lesions of the left main coronary artery. Surgery is associated with much better outcomes than medical therapy and is considered by many to be the standard of care in patients who are surgical candidates. Recent studies comparing surgery with percutaneous coronary intervention (PCI) have defined subgroups with lesser extent of disease burden that may do just as well with PCI. 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Recent studies have increased our understanding of the complexity of left main coronary artery disease. This lesion subset offers numerous challenges in diagnosis and management. Fractional flow reserve and intravascular ultrasound are important adjuncts to angiography to determine the significance of ambiguous lesions of the left main coronary artery. Surgery is associated with much better outcomes than medical therapy and is considered by many to be the standard of care in patients who are surgical candidates. Recent studies comparing surgery with percutaneous coronary intervention (PCI) have defined subgroups with lesser extent of disease burden that may do just as well with PCI. Challenges remain in the management of bifurcation disease, and the interventional community anxiously awaits the results of the large-scale randomized trials comparing PCI with surgery.</description><subject>Anticoagulants - therapeutic use</subject><subject>Cardiac Catheterization</subject><subject>Cardiovascular</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass - history</subject><subject>Coronary Artery Disease - classification</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - history</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Circulation</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Coronary Vessels - surgery</subject><subject>Diagnostic Imaging - methods</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Hemodynamics</subject><subject>History, 20th Century</subject><subject>History, 21st Century</subject><subject>Humans</subject><subject>Patient Selection</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - history</subject><subject>Percutaneous Coronary Intervention - instrumentation</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Predictive Value of Tests</subject><subject>Risk Factors</subject><subject>Stents</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><issn>0146-2806</issn><issn>1535-6280</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1v1DAQhi0EokvhL0COHDbBjr8SDkirBUqlrXpoOVuOM6m8JPbiyVbqv6-jbXvgxMEaj_3OO5pnCPnEaMUoU1_2lTs4m3ofx6qmTFSMVZTyV2TFJJelqhv6mqzyhyrzVZ2Rd4h7SlndMvWWnNVSKykkX5HbHQxzcWV9KLYxxWDTQ7FJM-Tw3SNYhK_F5XSIabbBwTo_2rsQ0eO62CAC4gRhXhc29Nkk2DtY8vfkzWBHhA9P8Zz8_vnjdvur3F1fXG43u9KJWs2l7ls1DLwbuAXgfd862YCWjkuuoNO6zUcJoaXSzdAJahuhWSdk23WN7KDm5-TzyfeQ4t8j4Gwmjw7G0QaIRzRMKVFTybXOUn2SuhQREwzmkPyUpzWMmgWp2ZsXpGZBahgzGWmu_PjU5NhN0L_UPTPMgs1JAHnUew_JoPOQafU-gZtNH_1_NPn2j4cbffDOjn_gAXAfjylkkoYZrA01N8tml8UyQSltW8YfAVDNoBM</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Ragosta, Michael, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150301</creationdate><title>Left Main Coronary Artery Disease: Importance, Diagnosis, Assessment, and Management</title><author>Ragosta, Michael, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-7d96ff3bf3aee3dd9c58e75c3536eb779b7764475678fb40a8471b459bb85be23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Anticoagulants - therapeutic use</topic><topic>Cardiac Catheterization</topic><topic>Cardiovascular</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Bypass - history</topic><topic>Coronary Artery Disease - classification</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - history</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary Circulation</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Coronary Vessels - surgery</topic><topic>Diagnostic Imaging - methods</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Hemodynamics</topic><topic>History, 20th Century</topic><topic>History, 21st Century</topic><topic>Humans</topic><topic>Patient Selection</topic><topic>Percutaneous Coronary Intervention - 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Recent studies have increased our understanding of the complexity of left main coronary artery disease. This lesion subset offers numerous challenges in diagnosis and management. Fractional flow reserve and intravascular ultrasound are important adjuncts to angiography to determine the significance of ambiguous lesions of the left main coronary artery. Surgery is associated with much better outcomes than medical therapy and is considered by many to be the standard of care in patients who are surgical candidates. Recent studies comparing surgery with percutaneous coronary intervention (PCI) have defined subgroups with lesser extent of disease burden that may do just as well with PCI. Challenges remain in the management of bifurcation disease, and the interventional community anxiously awaits the results of the large-scale randomized trials comparing PCI with surgery.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25765453</pmid><doi>10.1016/j.cpcardiol.2014.11.003</doi><tpages>34</tpages></addata></record> |
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| ispartof | Current problems in cardiology, 2015-03, Vol.40 (3), p.93-126 |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Anticoagulants - therapeutic use Cardiac Catheterization Cardiovascular Coronary Angiography Coronary Artery Bypass - adverse effects Coronary Artery Bypass - history Coronary Artery Disease - classification Coronary Artery Disease - diagnosis Coronary Artery Disease - history Coronary Artery Disease - physiopathology Coronary Artery Disease - surgery Coronary Artery Disease - therapy Coronary Circulation Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Coronary Vessels - surgery Diagnostic Imaging - methods Fibrinolytic Agents - therapeutic use Hemodynamics History, 20th Century History, 21st Century Humans Patient Selection Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - history Percutaneous Coronary Intervention - instrumentation Platelet Aggregation Inhibitors - therapeutic use Predictive Value of Tests Risk Factors Stents Treatment Outcome Ultrasonography, Interventional |
| title | Left Main Coronary Artery Disease: Importance, Diagnosis, Assessment, and Management |
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