Why the study?
Is percutaneous coronary intervention a safe and effective alternative to coronary artery bypass grafting in patients with severe left main stem stenosis?
Is percutaneous coronary intervention a safe and effective alternative to coronary artery bypass grafting in patients with severe left main stem stenosis?
PCI is a safe and effective alternative to CABG for carefully selected patients with left main coronary artery disease, with outcomes continually improving due to advanced stenting and imaging techniques.
PCI viable alternative to CABG in selected LMS cases; leaves open whether new techniques warrant guideline updates.
Pacienti s tÄĹžkou stenĂłzou kmene levĂŠ koronĂĄrnĂ tepny (left main stem, LMS) jsou vzhledem k rozsahu postiĹženĂ myokardu ve velmi vysokĂŠm riziku zĂĄvaĹžnĂ˝ch kardiovaskulĂĄrnĂch pĹĂhod. Po tĹech letech dosahuje mortalita farmakologicky lĂŠÄenĂ˝ch nemocnĂ˝ch s vĂ˝znamnou stenĂłzou LMS 50 %. Za zlatĂ˝ standard lĂŠÄby vĂ˝znamnĂŠ stenĂłzy LMS, zvlĂĄĹĄtÄ pĹi souÄasnĂŠm postiĹženĂ nÄkolika koronĂĄrnĂch tepen, je povaĹžovĂĄn aortokoronĂĄrnĂ bypass (CABG). Ĺada studiĂ prokĂĄzala, Ĺže perkutĂĄnnĂ koronĂĄrnĂ intervence (PCI) mĹŻĹže u pacientĹŻ peÄlivÄ vybranĂ˝ch tĂ˝mem kardiologĹŻ a kardiochirurgĹŻ pĹedstavovat bezpeÄnou a ĂşÄinnou alternativu CABG, s podobnou vĂ˝slednou mortalitou. VĂ˝sledky PCI na LMS se dĂky neustĂĄle dĂĄle vyvĂjenĂ˝m technikĂĄm PCI a pouĹžĂvĂĄnĂm novÄjĹĄĂch generacĂ lĂŠkovĂ˝ch stentĹŻ trvale zlepĹĄujĂ. Tyto vĂ˝sledky mohou navĂc dĂĄle zlepĹĄovat novÄ zavĂĄdÄnĂŠ rĹŻznĂŠ invazivnĂ zobrazovacĂ metody (intravaskulĂĄrnĂ ultrazvuk nebo optickĂĄ koherenÄnĂ tomografie), pĹĂpadnÄ rĹŻznĂŠ zpĹŻsoby vyĹĄetĹenĂ hemodynamickĂ˝ch pomÄrĹŻ (frakÄnĂ prĹŻtokovĂĄ rezerva). Tyto novinky v oblasti PCI LMS mohou v budoucnu vĂŠst ke zmÄnĂĄm souÄasnĂ˝ch doporuÄenĂ˝ch postupĹŻ v lĂŠÄbÄ postiĹženĂ kmene levĂŠ koronĂĄrnĂ tepny.
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Predescu et al. (2015) studied this question.
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