ALEA JACTA EST DEFINITION TRIAL

ALEA JACTA EST DEFINITION TRIAL

5 Patients with severe LMCA disease were excluded from most of the early clinical trials and, until recently, no specific trial compared the results of surgery vs PCI as one of its endpoints. 3, 4 HISTORIC PERSPECTIVEД¬oronary artery bypass graft (CABG) has been the standard of care for the management of patients with LMCA disease based on early clinical trials that proved its prognostic benefit in patients assigned to surgery compared to medical therapy. However, none of them has become the leading model yet. There are different models and scales to guide the selection of patients. Assessing anatomic spread correctly, the complexity of coronary artery disease, the patientвЂ™s comorbidities, and the operatorвЂ™s expertise in complex percutaneous coronary interventions (PCI) are key factors when choosing the right revascularization strategy. 2 Revascularization can be surgical or percutaneous, each one with its corresponding advantages and limitations. Without revascularization, its prognosis is poor and mortality rate can be up to 37% at 3-year follow-up. 1 Since the LMCA supplies over 75% of all the myocardial blood flow, the risk associated with its lesions is the highest of all possible coronary lesions. Significant left main coronary artery (LMCA) disease is present in 4% to 5% of all coronary angiographies. CirugГa de revascularizaciГіn coronaria.ДЄbbreviations: LAD: left anterior descending coronary artery. En tanto los estudios clГnicos futuros no se decanten definitivamente a favor de la revascularizaciГіn percutГЎnea o de la quirГєrgica, la discusiГіn individualizada de cada caso en un equipo multidisciplinario y las preferencias de los pacientes deberГan guiar la decisiГіn clГnica.

Los aspectos anatГіmicos, tГ©cnicos y de estrategia son fundamentales en el tratamiento percutГЎneo de estas lesiones, dada su enorme variabilidad clГnica. La realizaciГіn de estudios aleatorizados que han comparado ambas modalidades de revascularizaciГіn ha llevado al intervencionismo percutГЎneo a la altura de la cirugГa en un alto porcentaje de pacientes. Los cambios ocurridos en los Гєltimos 10-15 aГ±os, desde la apariciГіn de los stents farmacoactivos y su mejora tecnolГіgica, han sido vertiginosos. Hasta hace poco tiempo, los estudios clГnicos mГЎs relevantes en este campo, asГ como las guГas clГnicas, han sido favorables a la revascularizaciГіn quirГєrgica casi como forma exclusiva de tratamiento de esta patologГa.

La enfermedad del tronco coronario izquierdo ha permanecido muchos aГ±os como la Гєltima frontera que se resistГa al intervencionismo coronario percutГЎneo. As long as future clinical studies do not definitively favor percutaneous over surgical revascularization or vice versa, individual discussions on each particular case by the heart team and our patientsвЂ™ preferences should guide our clinical decision-making process. In this article we will be reviewing their anatomy, angiography, intracoronary diagnostic techniques, and different percutaneous revascularization strategies. The anatomical, technical, and strategic aspects are essential for the percutaneous management of left main coronary artery lesions given their tremendous clinical variability.

This, added to the publication of randomized clinical trials that compared both revascularization modalities, has placed percutaneous coronary interventions at a similar level to surgery in a large number of patients. The changes that have occurred over the last 10 to 15 years since the appearance of drug-eluting stents and their technological advances have been extraordinary. Until recently, the most relevant clinical studies in this regard as well as clinical practice guidelines favored surgical revascularization almost as the only treatment pathway for the management of this condition. For many years, left main coronary artery disease has remained as the last frontier resisting percutaneous coronary intervention.

Alea jacta est definition