The most recent poll addressed your thoughts about best revascularization options for significant left main disease. The first question asked how often you felt coronary artery bypass grafting surgery (CABG) was the optimal treatment in patients with significant obstruction. In 92% of cases, voters chose CABG as the preferred treatment in 50% or more instances. In only 8% of cases was CABG the preferred treatment. No one felt that in CABG was never the preferable treatment.

In a follow-up question, reasons regarding the most frequent reason for favoring CABG were predominantly in 2 categories: 49% favored CABG based on adverse anatomical considerations, and 42% favored CABG based on expected better long-term outcomes. Likely these two categories may represent some overlap because responders may believe that surgery would provide better outcomes because of anatomical considerations. Only 9% favored surgery for young patients with low comorbidities and expected excellent long-term results. No one favored surgery because they were not technically comfortable with performing a reasonable but complex anatomical procedure.

These results appear somewhat conservative with regard to the apparent competitive percutaneous coronary intervention outcomes based on the most recent EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) 5-year follow-up results. It should be noted that while the poll was up on the site, the NOBEL (Nordic–Baltic–British Left Main Revascularisation Study) 5-year results were released. Based on your responses, revascularization for left main disease is operator- and circumstance-dependent with continuing frequent use of CABG.

As always, thanks to those who participated.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Percutaneous Coronary Intervention, Coronary Artery Bypass, Coronary Artery Disease, Angiography, Coronary Angiography

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