Coronary angiography indicates LCA occlusion...

[SlaveOfTCMC]

First Aid and Kaplan (Conrad Fischer) seem to disagree on a minor point...

Left main coronary artery occlusion demands immediate CABG (Conrad Fisher)

However, First Aid says to "attempt PCI first"

A USMLERx question indicated to perform PCI first

A Kaplan qbank question indicated to go to CABG first


any future cardiology fellows out there know what the official ACC guidelines are?

---

Members don't see this ad.

 

[turkeyjerky]

Cabg

 

[Mr Cookie Pants]

Cabg

For the test. Good luck getting a cardiologist who has a cath in there to not try and stent isolated left main disease. in fact, apparently there's apparently some research thats showing PCI to be as good as CABG at left main disease, thus taking one more feather out of CT's cap and turning it to T Surgery.

For the test,
Left main and 3 vessel disease are CABG.

 

[SlaveOfTCMC]

thanks for your help.

 

[turkeyjerky]

At my institution these people get taken off the table, a CT surgery consult and discussion w/ the patient regarding the benefits and risks associated w/ surgery vs PCI. Blowing up a balloon in the left-main is not a benign endeavor.

 

[dangit]

Don't know if this would help, but according to the BARI study, mortality rate is higher in diabetic patients with PCI than CABG.

Bottom line, if you have a diabetic patient with CAD, do a CABG.

For those without diabetes, it doesn't matter whether you do CABG or PCI because both have a similar mortality rate, but PCI is preferred since it's obviously less invasive.