Left main and multivessel disease

Aaysha Cader interviews Barbara Elisabeth Stahli on the study design and results that she presented during the ESC Congress 2023 in Amsterdam. 

Immediate multivessel PCI was non-inferior to staged multivessel PCI for reducing death and ischemic events in patients with STEMI and multivessel coronary artery disease.

Luis Ortega-Paz interviews Simone Biscaglia and Gianluca Campo about the FIRE trial.
Results showed elderly patients presenting with either STEMI or NSTEMI benefit from complete revascularization, reducing cardiovascular events risk at 1 year compared to culprit lesion-only PCI.

Published simultaneously in the New England Journal of Medicine

This patient-level analysis of randomized trials comparing PCI vs CABG for the treatment of low-to-intermediate CAD involving the LM confirms the absence of long-term differences in mortality between revascularization techniques, regardless of the clinical presentation.

While the choice between PCI and CABG for LMCA disease continues to be one of the most controversial topics, patient characteristics & comorbidities must be taken into account, as must the external validity of the results of RCTs in the real world, as the SWEDEHEART registry does.

How would you treat an extremely calcified sub-occluded LM in a 72-year-old man presenting on "dependent stability and sliding on inotropes"(*), refused by surgery?

(*) INTERMACS III to II

A 71-year-old woman was referred for coronary angiography. She underwent SAVR for AS related to bicuspidia 6 months before, and subsequently suffered from angina and increasing dyspnea 4 months after the intervention...

A 68-year-old non-diabetic male patient presented with recent exertional chest pain and good LV function. Baseline angiography revealed severe stenosis of the proximal RCA, mid-stenosis of the proximal and mid-CX, and mid-stenosis of the proximal and mid-LAD.

Physiology revealed significant stenosis of proximal CX and proximal LAD.

IVUS...

Because multivessel disease raises many challenges, cardiac surgeon Lenard Conradi and interventional cardiologist Davide Capodanno discuss the biggest ones.

Is invasive coronary angiography really necessary? If revascularisation is required, which patient should be given a PCI rather than a CABG, and vice versa? What is state-of-the-art in surgery in...

Watch the case of a 62-year-old non-diabetic male patient with history of stroke and peripheral artery disease, normal ECG and left ventricular function, referred for CT scan and angiography. He presented with calcified distal LM stenosis and calcified proximal LAD stenosis.

Provisional left main stenting was performed,...

Explore the world of intracoronary imaging in left main interventions in this session: discover a fascinating case report on overcoming left main stent pop-up, delve into the application of OCT-guided nano crush technique for left main bifurcation lesions, uncover the management of stent failure involving the...