I see no significant difference between PCI and CABG in any of these trials for those with left main obstruction. You have also presented studies comparing "optimal medical management" with each of those interventions in patients with significant coronary disease without a left main component. It would be interesting to see if there is also no difference between medical management and either type of intervention in those with left main lesions comparable to those presented in the other studies. I doubt that there is much reliable data on that because such studies would have some logistical and ethical problems. I recall that at least one of the papers on medical management did show some advantage in the subgroup analysis for CABG but that the numbers were pretty small.
That's a good question. To the best of our knowledge, no trial exclusively randomized patients with left main disease to medical therapy vs intervention (either PCI or CABG).
I see no significant difference between PCI and CABG in any of these trials for those with left main obstruction. You have also presented studies comparing "optimal medical management" with each of those interventions in patients with significant coronary disease without a left main component. It would be interesting to see if there is also no difference between medical management and either type of intervention in those with left main lesions comparable to those presented in the other studies. I doubt that there is much reliable data on that because such studies would have some logistical and ethical problems. I recall that at least one of the papers on medical management did show some advantage in the subgroup analysis for CABG but that the numbers were pretty small.
That's a good question. To the best of our knowledge, no trial exclusively randomized patients with left main disease to medical therapy vs intervention (either PCI or CABG).
Patients with left main disease were included in the Veterans Administration Cooperative Study (link below), however, the number of patients with left main disease was low (around a 100). https://cardiologytrials.substack.com/p/review-of-the-veterans-administration
Thank you for the response and the link to the VA study. That was the one I was remembering.