Invasive Treatment of Left Main Coronary Artery Disease: FromAnatomical Features to Mechanistic Differences

Fig. (1). Anatomical analysis of the coronary system and its detection from obstructive coronary artery disease in 26,644 coronary segments, of which 16,298 were treated with PCI (92%) or with CABG (8%). The left main disease was present in 5% of the cases and was associated with multi-vessel affection in 60% of the cases (8) (reproduced with permission). Cx: Circumflex Artery, LAD: Left Anterior Descending Artery, LMCA: Left Main Coronary Artery, LPD: Left Posterior Descending Artery, PDA: Posterior Descending Artery, RCA: Right Coronary Artery, RPD: Right Posterior Descending Artery.

Fig. (2). A: All-cause mortality in EXCEL patients (11) (reproduced with permission). B: All-cause mortality in NOBLE patients (12) (reproduced with permission). C: All-cause mortality (16) (reproduced with permission) and D: incidences of myocardial infractions from the patient-data meta-analysis comparing CABG and PCI in the left main disease (16) (reproduced with permission). CI: Confidence Interval, HR: Hazard Ratio.

Fig. (3). Central Illustration from a meta-analysis comparing CABG and PCI in left main disease focusing on the site of the left main lesion (19) (reproduced with permission). CAD: Coronary Artery Disease, LAD: Left Anterior Descending Artery, LCx: Left Circumflex Artery, MACE: Major Adverse Cardiovascular Events, MI: Myocardial Infarction.

Fig. (4). A: All-cause mortality in the STICH trial (29) (reproduced with permission). B: All-cause mortality or heart failure rehospitalization in the REVIVED BCIS-2 trial (30) (reproduced with permission). C: Change in EF from Baseline to 4 months after treatment with CABG or medical therapy in the STICH trial (51) (reproduced with permission). D: EF over time with either PCI or medical treatment in the REVIVED BCIS-2 trial (30) (reproduced with permission). CI: Confidence Interval, HR: Hazard Ratio, LVEF: Left Ventricular Ejection Fraction, MED: Medical Therapy.

Fig. (5). A: Comparison of cardiovascular risk from obstructive and non-obstructive coronary artery disease from CT calcium scoring studies (36) (reproduced with permission). B: Quantification of myocardial infarction occurrence as a function of stenosis severity of the underlying atherosclerotic lesion (21) (reproduced with permission). C: illustration of the mechanistic principle of surgical collateralization (21) (reproduced with permission). D: Relationship between a CABG-associated survival advantage and its ability to prevent myocardial infarctions (39) (reproduced with permission). CAC: Coronary Artery Calcium, CI: Confidence Interval, CV: Cardiovascular, IRR: Incidence Rate Ratio, MI: Myocardial Infarction, SMI: Spontaneous Myocardial Infarction.

Fig. (6). Illustration of the mechanisms underlying current invasive treatment options for coronary artery disease (43) (reproduced with permission). ACS: Acute Coronary Syndrome, CCS: Canadian Cardiovascular Society, CHD: Coronary Heart Disease, MI: Myocardial Infarction.