Transcript Comparison of optical coherence tomography and

GISE 2013, October, 9, 2013 – Slide 1
LM Updates 2013 - Capodanno
Upgrade your technique: Standards of Left Main PCI in 2013
Reviewing The Most Contemporary
Trial Data On Left Main PCI
Davide Capodanno, MD, PhD
University of Catania
Ferrarotto Hospital
University of Catania
LM Updates 2013 - Capodanno
GISE 2013, October, 9, 2013 – Slide 2
Methods
 PubMed/MedLine search for “Left main”

left main[Title] AND ("N Engl J Med"[Journal] OR "JAMA"[Journal] OR "Lancet"[Journal] OR ("Circulation"[Journal]
OR "Circ Heart Fail"[Journal] OR "Circ Cardiovasc Qual Outcomes"[Journal] OR "Circ Cardiovasc Interv"[Journal]
OR "Circ Cardiovasc Imaging"[Journal] OR "Circ Cardiovasc Genet"[Journal] OR "Circ Arrhythm
Electrophysiol"[Journal]) OR "J Am Coll Cardiol"[Journal] OR ("Europ Heart J Acute Cardiovasc Care"[Journal] OR
"Eur Heart J"[Journal]) OR "Am Heart J"[Journal] OR "Am J Cardiol"[Journal] OR "EuroIntervention"[Journal] OR
(("JACC Heart Fail"[Journal] OR "jacc"[All Fields] OR "JACC Cardiovasc Interv"[Journal] OR "jacc"[All Fields] OR
"JACC Cardiovasc Imaging"[Journal] OR "jacc"[All Fields] OR "J Am Coll Cardiol"[Journal] OR "jacc"[All Fields])
AND ("JACC Cardiovasc Interv"[Journal] OR "Int J Cardiovasc Intervent"[Journal] OR "Circ Cardiovasc
Interv"[Journal])) OR (Circ[All Fields] AND ("JACC Cardiovasc Interv"[Journal] OR "Int J Cardiovasc
Intervent"[Journal] OR "Circ Cardiovasc Interv"[Journal])) OR "Catheter Cardiovasc Interv"[Journal] OR "J Interv
Cardiol"[Journal] OR "J Invasive Cardiol"[Journal] OR "Int J Cardiol"[Journal]) AND ("2012/10/05"[PDAT] :
"2013/10/08"[PDAT])
 Search restricted from October 5, 2012 (one day after GISE 2012) to
October 8, 2013 (yesterday)
 93 manuscript published

Studies illustrated in this presentation were filtered/added from other sources as per
relevance to the topic, personal preference and time constraints
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 3
LM Updates 2013 - Capodanno
Trends In Left Main Publications*
120
103
100
102
90
83
80
76
60
58
40
20
90
38
24
26
29
19
0
*Pubmed hits since 2010 using the search strategy described before
Ferrarotto Hospital
University of Catania
93
GISE 2013, October, 9, 2013 – Slide 4
LM Updates 2013 - Capodanno
Left Main Overview: Topics To Cover
Risk Stratification and Decision Making
PCI Procedure
Outcomes Data / Stents
Patient and Lesion Scenarios
PCI versus CABG
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 5
LM Updates 2013 - Capodanno
Left Main Overview: Topics To Cover
Risk Stratification and Decision Making
PCI Procedure
Outcomes Data / Stents
Patient and Lesion Scenarios
PCI versus CABG
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 6
LM Updates 2013 - Capodanno
Post PCI or
CABG
Prior to PCI or CABG
Anatomic
Assesment
Clinical
Assesment
Combined
Assesment
Functional
Assesment
Post-Revasc.
Assesment
SYNTAX
Score
EuroSCORE
Global Risk
Classification
Functional
CABG
SYNTAX Score
SYNTAX Score
MSCT
ACEF
Clinical
Residual
SYNTAX score
SYNTAX Score
SYNTAX Score
Logistic CSS
SYNTAX
Score 2
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 7
LM Updates 2013 - Capodanno
Post PCI or
CABG
Prior to PCI or CABG
Anatomic
Assesment
Clinical
Assesment
Combined
Assesment
Functional
Assesment
Post-Revasc.
Assesment
SYNTAX
Score
EuroSCORE
Global Risk
Classification
Functional
CABG
SYNTAX Score
SYNTAX Score
MSCT
ACEF
Clinical
Residual
SYNTAX score
SYNTAX Score
SYNTAX Score
Logistic CSS
SYNTAX
Score 2
Ferrarotto Hospital
University of Catania
LM Updates 2013 - Capodanno
GISE 2013, October, 9, 2013 – Slide 8
Assessing the SYNTAX Score Prior to Coronary Angiography
The Computed Tomography-derived SYNTAX Score
High correlation between the 2 rounds of analyses for the MSCT SXscores (r = 0.95, p < 0.001). The intraobserver variability for the
MSCT SXscore tertiles showed substantial agreement (kappa = 0.80; 95% confidence interval, 0.67 to 0.94)
Ferrarotto Hospital
Papadopoulou et al. JACC Cardiovasc Imaging. 2013;6:413-5
University of Catania
GISE 2013, October, 9, 2013 – Slide 9
LM Updates 2013 - Capodanno
External Validation of the Logistic Clinical SYNTAX Score For Prediction
Of 1-year Mortality After Left Main PCI (From the CUSTOMIZE Registry)
Logistic Clinical SXscore – 1-Year Death (Farooq V, et al. Eur Heart J. 2012;33:3098-104)
Logit (Death) = -7.5478 + 0.0241 * SXscore + 0.0396 * age + 0.0748 * (50-LVEF)+ + 0.0235 * (90-CrCl)+ + 0.3649 * SYNTAX-like
Risk stratification
Ferrarotto Hospital
University of Catania
Calibration
Capodanno et al. CCI 2013 Apr 16. doi: 10.1002/ccd.24944
GISE 2013, October, 9, 2013 – Slide 10
LM Updates 2013 - Capodanno
Personalizing Risk
Assessment for PCI or CABG
The SYNTAX Score 2
(From the SYNTAX trial)
Rationale: Low, intermediate,
and high categories of anatomical
complexity in the SYNTAX score hide
lower risk patients in the higher SYNTAX
score groups, and viceversa
Strength: Enables direct, personalized
comparisons of long-term estimates of
mortality for individual patients with LM or
3VD disease referred to PCI or CABG
Online version under development
Ferrarotto Hospital
University of Catania
Farooq V, et al. Lancet 2013;381:639–50
GISE 2013, October, 9, 2013 – Slide 11
LM Updates 2013 - Capodanno
Grading Incomplete Revascularization After Left Main CABG
The CABG SYNTAX Score
The CABG SYNTAX score is essentially the SYNTAX score of the “native”
coronary vessels, with points deducted based on the vessel-segment weighting
of the bypassed coronary vessel
Validation Of The CABG SYNTAX score For Prediction Of 5-Year Clinical Outcomes (from the SYNTAX-LE MANS Substudy)
Ferrarotto Hospital
University of Catania
Farooq et al. EuroIntervention. 2013;8:1277-85
Farooq et al. EuroIntervention 2013; online publish - AOP
GISE 2013, October, 9, 2013 – Slide 12
LM Updates 2013 - Capodanno
Grading Incomplete Revascularization After Left Main PCI
The Residual SYNTAX Score
1-Y Death
P < 0.001
Malkin et al.
CCI 2013;81:939-46
Ferrarotto Hospital
University of Catania
2-Y Cardiac Death
P < 0.001
Capodanno D et al.
CCI 2013;82:333-40
5-Y Death
P < 0.001
Farooq et al. (SYNTAX)
Circulation. 2013;128:141-51
GISE 2013, October, 9, 2013 – Slide 13
LM Updates 2013 - Capodanno
Left Main Overview: Topics To Cover
Risk Stratification and Decision Making
PCI Procedure
Outcomes Data / Stents
Patient and Lesion Scenarios
PCI versus CABG
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 14
LM Updates 2013 - Capodanno
7th Consensus From The European Bifurcation Club
Left Main Bifurcation PCI
• For LMCA treatment, PCI and CABG have similar safety outcomes
at 12-month follow-up. PCI has a lower risk of stroke but a higher
risk of repeat intervention.
• PCI with DES has excellent outcomes for ostial or mid-shaft left
main lesions, but has a higher incidence of TLR for distal left main
stem bifurcation lesions.
• Left main stem plaque distribution may help determine optimal
revascularisation strategy
• The distal bifurcation angle affects the selection of left main
stenting strategies. However, there is still controversy as to
whether or not bifurcation angles might affect clinical outcomes.
• IVUS guidance for LMCA bifurcation intervention is recommended
Ferrarotto Hospital
University of Catania
Stankovic et al. Eurointervention 2013;9:36-45
GISE 2013, October, 9, 2013 – Slide 15
LM Updates 2013 - Capodanno
Maximal Expansion Capacity With
Current DES Platforms: A Critical
Factor For Stent Selection In The
Treatment Of Left Main
Bifurcations?
Ferrarotto Hospital
University of Catania
•
Expansion capacity for each stent
diameter is limited by its design.
•
Most stents can be expanded well above
their labelled diameter and recommended
maximal diameter for post-expansion.
•
Despite most stents achieving larger
MLD, excessive overexpansion leaves
large gaps between rings that may affect
the ability of the stent to scaffold an
atherosclerotic plaque lesion and the
effectiveness of the antiproliferative drug
coating to prevent restenosis.
Foin et al. Eurointervention 2013;8:1315-25
GISE 2013, October, 9, 2013 – Slide 16
LM Updates 2013 - Capodanno
Single-stent crossover technique from distal unprotected
left main coronary artery to the left circumflex artery
The Milan Registry
Single-stenting with DES for distal unprotected LM disease performed in 584 patients.
31 patients underwent LMCA–LCx stenting, 553 underwent LMCA–LAD stenting.
3-Y MACE
TLR (Overall)
TLR (Stented Branch)
Ferrarotto Hospital Naganuma et al. Catheter Cardiovasc Interv. 2013 May 15. AOP
University of Catania
GISE 2013, October, 9, 2013 – Slide 17
LM Updates 2013 - Capodanno
Five-year MACE of Left Main Bifurcation Lesion Stenting: OneStent Versus Two-Stent Techniques Versus DK Crush Technique.
The Chinese Experience
1 Stent vs 2 Stents
Ferrarotto Hospital
University of Catania
One stent vs DK Crush
1 Stent vs 2 Stents (Others)
Chen et al. EuroIntervention. 2012;8:803-14
GISE 2013, October, 9, 2013 – Slide 18
LM Updates 2013 - Capodanno
Double Kissing Crush Versus Culotte stenting For Unprotected
Distal Left Main Bifurcation Lesions
DKCRUSH-III
• Compared to the DK crush, Culotte
stenting was associated with
significantly increased MACEs at 12
months
• DK crush was associated with
• less in-stent restenosis of SB
• less TLR/TVR
Ferrarotto Hospital
University of Catania
Chen et al. J Am Coll Cardiol. 2013;61:1482-8
LM Updates 2013 - Capodanno
GISE 2013, October, 9, 2013 – Slide 19
Studies of Imaging/Functional Assessment
•
3D-IVUS LMCA bifurcation lumen changes after cross-over single-stent implantation
were determined primarily by conformational changes in vessel geometry. (Xiu et al.
Catheter Cardiovasc Interv. 2013;81:1142-9)
•
3D-QCA software has fair agreement when compared with IVUS for imaging of LM
MLD and MLA, being potentially helpful to guide intervention of the LM (Spoon et al.
Catheter Cardiovasc Interv. 2013;81:1156-61)
•
FD-OCT achieves imaging completeness less often than IVUS, whereas it is more
sensitive in detecting malapposition and edge dissections, and similar to IVUS in the
assessment of lumen and stent dimensions (Fujino et al. Catheter Cardiovasc Interv.
2013;82:173-83)
•
IVUS of LAD/D1 and LMCA bifurcations reveals that most lesions had diffuse plaques
extending from the MV into the MB with the SB having the least amount of calcium and
the smallest plaque burden, regardless of location. (Yakushiji T, EuroIntervention.
2013;8:1040-6)
•
FFR measurement may be modestly overestimated in the presence of downstream
epicardial disease despite measuring FFR in a nondiseased epicardial vessel. (Yong et
al Circ Cardiovasc Interv. 2013;6:161-5)
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 20
LM Updates 2013 - Capodanno
30-Day impact of Bivalirudin on short-term outcomes after LM PCI
Pooled analysis from REPLACE-2, ACUITY, and HORIZONS-AMI trials
Death, MI, uTVR
non-CABG-related major bleeding
NACE
Ferrarotto Hospital
University of Catania
Geisler et al. Eurointervention 2013 Ahead of print
GISE 2013, October, 9, 2013 – Slide 21
LM Updates 2013 - Capodanno
Platelet Inhibition With Prasugrel Versus Clopidogrel In Patients
Undergoing Left Main PCI With Everolimus-Eluting Stents
The FLORENCE Left Main Registry (N=252)
N=104
N=148
Adjusted hazard ratio 0.17
95% CI 0.04-0.77, P=0.022
The incidence of major bleeding was low and similar in both groups (1.9% in the clopidogrel group and 2.7% in the prasugrel group,
P=0.689)
Ferrarotto Hospital
University of Catania
Migliorini et al. Am J Cardiol. 2013 Ahead of Print
GISE 2013, October, 9, 2013 – Slide 22
LM Updates 2013 - Capodanno
Left Main Overview: Topics To Cover
Risk Stratification and Decision Making
PCI Procedure
Outcomes Data / Stents
Patient and Lesion Scenarios
PCI versus CABG
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 23
LM Updates 2013 - Capodanno
Very long-term outcomes after PCI with bare metal stents for
unprotected left main coronary artery disease
Device-Oriented Outcomes
•
•
Patient-Oriented Outcomes
Smaller LMT diameter was independently associated with TLR
SYNTAX score was independently associated with MACE
Ferrarotto Hospital
University of Catania
Nomura et al. EuroIntervention. 2012;8:962-9
GISE 2013, October, 9, 2013 – Slide 24
LM Updates 2013 - Capodanno
5-Year Outcomes of First-Generation DES
The Japanese (N=582) and French (N=291) Registries
J-CYPHER
FLM-TAXUS
JACC Cardiovasc Interv. 2013;6:654-63.
EuroIntervention. 2012;8:970-81
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 25
LM Updates 2013 - Capodanno
Second- vs First-generation DES
Adj. HR (EES): 0.42, 95%
CI 0.19-0.92, P=0.03
1-year MACE
P=0.12
Adj. HR (PES): 2.36, 95%
CI 1.16-4.82, P=0.02
2-year TLF
P=0.01
Propensity adjusted
166 matched pairs
1-year MACE
P=0.01
Propensity adjusted
200 matched pairs
3-year MACE
P=0.60
EXCELLENT
(N=275)
FML-T/LEMAX
(N=344)
FLORENCE
(N=390)
ESTROFA-LM
(N=770)
Int J Cardiol.
2013 Apr 24. AOP
EuroIntervention.
2013;9:452-62.
J Am Coll Cardiol.
2012;60:1217-22
J Am J Cardiol.
2013;111:676-83
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 26
LM Updates 2013 - Capodanno
Second- vs First-Generation DES
Meta-Analysis Of 2,231 Patients From 4 Adjusted/Matched OSs
Studies
N
Random
effects
P
Fixed
effects
P
I2, %
P
Systematic
bias, P
Death
3
1,461
1.04
(0.69-1.58)
0.25
1.04
(0.69-1.58)
0.25
0
0.48
0.12
Non fatal
MI
3
1,461
0.58
(0.22-1.53)
0.27
0.60
(0.27-1.32)
0.21
32
0.23
0.60
TVF/TLR
4
2,231
0.78
(0.41-1.49)
0.45
0.85
(0.61-1.17)
0.31
73
0.01
1.00
ST
4
2,231
0.51
(0.22-1.15)
0.11
0.51
(0.22-1.15)
0.11
0
0.40
0.50
Ferrarotto Hospital
University of Catania
Capodanno et al. Int J Cardiol 2013 3 Apr 30. AOP
GISE 2013, October, 9, 2013 – Slide 27
LM Updates 2013 - Capodanno
Zotarolimus- versus Everolimus-Eluting Stents
ISAR LEFT MAIN 2
Cumulative incidence, %
100
RR 1.26 (95% CI 0.85-1.85), P= .25
80
60
Resolute
Xience
40
17.5%
20
14.3%
0
0
1
Ferrarotto Hospital
University of Catania
2
3
4
5
6
7
8
Months after randomization
9
Mehilli et al. J Am Coll Cardiol. 2013 Aug 8. AOP
10
11
12
GISE 2013, October, 9, 2013 – Slide 28
LM Updates 2013 - Capodanno
Six-Month Clinical Outcome in
Patients Treated With a
Dedicated Bifurcation Stent For
Left Main Disease
The TRYTON LM Registry
•
High rate of device and procedural success
•
Excellent angiographic result with optimal
acute luminal gain in all three segments of
the bifurcation.
•
BA changes observed to similar extents as
previously described for two-stent
techniques, but not associated with adverse
events at follow-up.
•
TLR was due almost exclusively to SB
ostium restenosis
Ferrarotto Hospital
University of Catania
Magro et al. EuroIntervention. 2013;8:1259-69.
GISE 2013, October, 9, 2013 – Slide 29
LM Updates 2013 - Capodanno
Left Main Overview: Topics To Cover
Risk Stratification and Decision Making
PCI Procedure
Outcomes Data / Stents
Patient and Lesion Scenarios
PCI versus CABG
Ferrarotto Hospital
University of Catania
LM Updates 2013 - Capodanno
GISE 2013, October, 9, 2013 – Slide 30
Left Main Subsets
Three Subanalyses From The MITO (Milan-Tokyo) Registry
•
PCI with DES for LM trifurcation stenosis (N=84) is feasible with a high
procedural success rate and no definite/probable ST reported at follow-up. A
true trifurcation lesion is associated with enhanced risk of MACE mainly
driven by TLR (Ielasi et al. Catheter Cardiovasc Interv. 2013 Aug 27. AOP)
•
Cardiac-death occurs more frequently in patients with residual CTO-RCA
(N=46) as compared with those without residual CTO-RCA (N=522).
Recanalization of CTO-RCA may have significant impact on the long-term
cardiac-mortality of LM PCI, probably by offering reserve coronary
circulation, if in-stent restenosis were to occur in the treated left main (Takagi
et al. Circ Cardiovasc Interv. 2013;6:154-60)
•
MB-ISR (N=53) is positively predicted by presence of calcification, truebifurcation and insulin-DM, and negatively predicted by full LM cover
approach, final proximal post-dilatation and greater MLD (Takagi et al. Catheter
Cardiovasc Interv. 2013 Sep 2 AOP)
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 31
LM Updates 2013 - Capodanno
STEMI
Primary PCI of
Unprotected Left Main
Culprit Lesion In The
Setting Of Acute
Myocardial Infarction
(977 Patients From 13 OSs)
Ferrarotto Hospital
University of Catania
Vis et al. JACC Cardiovasc Interv 2013;6:317-24
GISE 2013, October, 9, 2013 – Slide 32
LM Updates 2013 - Capodanno
Left Main Overview: Topics To Cover
Risk Stratification and Decision Making
PCI Procedure
Outcomes Data / Stents
Patient and Lesion Scenarios
PCI versus CABG
Ferrarotto Hospital
University of Catania
GISE 2013, October, 9, 2013 – Slide 33
LM Updates 2013 - Capodanno
One-Year Outcomes of PCI vs CABG in LM patients <75
versus ≥75 years (from the CUSTOMIZE Registry)
≥ 75 years
< 75 years
25%
25%
P=0.01
P=0.92
P=0.52
P=0.001
20%
P=0.65
P=0.49
P=0.80
P=0.11
20%
16%
16%
15%
15%
14%
11%
10%
9%
9%
5%
10%
10%
6%
5%
5%
5%
2%
1%
1%
1%
0%
2%
1%
0%
MACE
Death
PCI
MI
CABG
MACE
Death
PCI
Adjusted HR for 1-Year MACE
2.2 (95% CI 1.2–4.1), P=0.016
Ferrarotto Hospital
University of Catania
TLR
MI
CABG
Adjusted HR for 1-Year MACE
0.9 (95% CI 0.3–3.0), P=0.88
Capodanno et al. Am J Cardiol 2012;110:1452–1458
TLR
GISE 2013, October, 9, 2013 – Slide 34
LM Updates 2013 - Capodanno
SYNTAX – Final 5-Year Results
Left Main Cohort (N=705)
Ferrarotto Hospital
University of Catania
Mohr, et al. Lancet 2013;381:629–38
GISE 2013, October, 9, 2013 – Slide 35
LM Updates 2013 - Capodanno
Three More Overlapping Meta-Analyses!
Authors
Year
Effect (95% CI)
for MACCE
Effect (95% CI)
for mortality
Effect (95% CI)
for MI
Effect (95% CI)
for stroke
Effect (95% CI)
for Rep Revasc
Pooled
patients
Studies included
Biondi Zoccai et al
2008
0.46 (0.24-0.90)
NA
NA
NA
NA
670
3 OSs
Naik et al
2009
1.16 (0.68–1.96)
1.11 (0.66–1.85)
NA
NA
4.01 (2.01–7.98)
3,773
2 RCTs, 8 OSs
Lee et al
2010
NA
1.12 (0.80-1.56)
0.70 (0.45-1.09)
NA
0.44 (0.32-0.59)
2,905
2 RCTs, 8 OSs
Capodanno et al
2011
1.28 (0.95-1.72)
0.74 (0.43-1.29)
0.98 (0.54-1.78)
0.15 (0.03-0.67)
2.25 (1.54-3.29)
1,611
4 RCTs
Ferrante et al
2011
1.24 (0.93-1.67)
0.72 (0.42-1.24)
0.97 (0.54-1.74)
0.14 (0.04-0.55)
2.17 (1.48-3.17)
1,611
4 RCTs
Kajimoto et al
2012
0.55 (0.43-0.70)
0.92 (0.60-1.40)
0.67 (0.43-1.05)
NA
0.40 (0.30-0.55)
2,601
3 RCTs
Jang et al
2012
NA
0.68 (0.45-1.02)
1.07, (0.65-1.76)
0.23 (0.09-0.58)
3.52 (2.72-4.56)
5,079
3 RCTs, 9 OSs
Gao et al
2012
NA
0.97 (0.81-1.15)
NA
0.29 (0.16-0.51)
4.44 (3.42-5.78)
6,992
11 RCTs, 2 OSs
Alam et al
2013
1.20 (0.92-1.56)
0.81 (0.62-1.06)
1.32 (0.91-1.91)
0.31 (0.20-0.49)
3.73 (2.71-5.14)
11,148
4 RCTs, 23 OSs
Desch et al
2013
1.26 (1.02-1.57)
0.74 (0.46-1.19)
1.19 (0.69-2.06)
0.26 (0.10-0.69)
1.94 (1.43-2.61)
1,611
4 RCTs
Sa et al
2013
1.61 (NA),
p<0.001
0.69 (NA), p=0.05
NA
NA
3.60 (NA),
p<0.001
5,674
3 RCTs, 13 OSs
Ferrarotto Hospital
University of Catania
Modified from Osnabrugge, Capodanno, et al.
Eurointervention 2013 In press
GISE 2013, October, 9, 2013 – Slide 36
LM Updates 2013 - Capodanno
PCI vs CABG
RCTs
Re-Assessing the Comparative Effectiveness of CABG vs PCI vs
Medical Therapy in Left Main Disease
A Bayesian Cross-Design And Network Approach
SYNTAX LM
LEMANS
Evidence for the ACCF/AHA Class IIa recommendation for PCI to
improve survival in patients with ULMCAD
Boudriot et al.
PRECOMBAT
White et al.
MAIN COMPARE
Wu et al.
PCI vs CABG
OSs
Brener et al.
Chieffo et al.
Makikallio et al.
Palmerini et al.
Sanmartin et al.
Takaro et al.
Chaitman et al.
CABG vs MT
2 RCT, 5 OSs
Oberman et al.
Cohen et al.
Talano et al.
ECCS
APPROACH
Ferrarotto Hospital
University of Catania
Knowledge base to show that CABG confers a survival advantage
over MT in patients with ULMCAD
Bittl et al. Circulation. 2013;127:2177-2185
GISE 2013, October, 9, 2013 – Slide 37
LM Updates 2013 - Capodanno
2013 ESC Guidelines For Stable CAD
a50%
stenosis and proof of ischaemia, >70% stenosis in two angiographic views, or fractional fow reserve <0.80.
option in general.
bPreferred
Ferrarotto Hospital
University of Catania
Montalescot et al. Eur Heart J 2013 Ahead Of Print