Key result
Revascularizing physiologically significant left main disease is linked to ~58% fewer major events versus deferral.
Why the study?
Most revascularization trials exclude left main disease, leaving contemporary clinical outcomes of stable coronary disease and left main disease with proven ischemia poorly understood.
Does coronary revascularization reduce the composite of death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization in patients with stable coronary artery disease and physiologically significant left main coronary disease compared to revascularization deferral?
Cohort (n=225)
Yes
Does coronary revascularization reduce the composite of death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization in patients with stable coronary artery disease and physiologically significant left main coronary disease compared to revascularization deferral?
Hazard Ratio: 0.42 (95% CI 0.2–0.89)
Absolute Event Rate: 14.9% vs 28.4%
p-value: p=0.023
In patients with stable coronary artery disease and hemodynamically significant left main disease (iFR ≤0.89), performing revascularization significantly reduces the risk of death, MI, and target lesion revascularization compared to deferring treatment.
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Revascularization was associated with fewer events in significant left main disease; leaves open need for randomized confirmation before practice change.
Warisawa et al. (2023) conducted a cohort in Stable coronary artery disease with physiologically significant left main disease (n=225). Coronary revascularization vs. Revascularization deferral was evaluated on Composite of death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization of left main stem (HR 0.42, 95% CI 0.20-0.89, p=0.023). Coronary revascularization for physiologically significant left main disease reduced death, MI, or target lesion revascularization compared to deferral (HR 0.42; 95% CI 0.20-0.89; P=0.023).
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