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Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline

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dc.contributor.authorLamelas, Pablo
dc.contributor.authorPompeu, Michel
dc.contributor.authorIzcovich, Ariel
dc.contributor.authorBottaro, Federico
dc.contributor.authorTisi Baña, Matias
dc.contributor.authorSosa Liprandi, María Inés
dc.contributor.authorLanas, Fernando
dc.contributor.authorVilca Mejia, Omar Asdrúbal
dc.contributor.authorZuñiga Luna, Mauricio
dc.contributor.authorAubanel, Patricia
dc.contributor.authorMunera, Ana
dc.contributor.authorContreras Reyes, Juan
dc.contributor.authorBagur, Rodrigo
dc.contributor.authorWhitlock, Richard
dc.contributor.authorGarcia Garcia, Héctor
dc.contributor.authorMamas Mamas
dc.contributor.authorCohen, Mauricio G.
dc.contributor.authorRicalde, Alejandro
dc.contributor.authorAbizaid, Alexandre
dc.contributor.authorMendiz, Oscar
dc.contributor.authorAraya, Mario
dc.contributor.authorCosta, Ricardo
dc.contributor.authorSantaera, Omar
dc.contributor.authorHidalgo, Pedro
dc.contributor.authorCaldonazo, Tulio
dc.contributor.authorBaranchuk, Adrian
dc.contributor.authorRagusa, Martin Alberto
dc.contributor.authorSOLACI
dc.contributor.authorSIAC
dc.date.accessioned2026-07-24T15:31:04Z
dc.date.available2026-07-24T15:31:04Z
dc.date.issued2025
dc.description.abstractBackground Severe left main coronary artery disease (LMD) poses a major treatment challenge in Latin America, where both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used. Methods This guideline was developed de novo using the GRADE approach. A multidisciplinary panel reviewed evidence from a systematic review of randomized trials comparing PCI and CABG, incorporating a comprehensive literature search of patient values and preferences and outcome utilities. Thresholds were assigned for each clinical outcome, from small to large effect. Results Five randomized trials enrolling 4612 patients were included. At 30 days, PCI resulted in a large reduction in major bleeding and a small reduction in strokes. At 5 years, PCI was associated with a small to moderate increase of spontaneous myocardial infarction and a moderate to large increase in repeat revascularization. No important differences in short- or long-term mortality were observed between PCI and CABG. The overall certainty of evidence was rated low. There was a notable variability in patient values and a close call on the balance of effects. Conclusions For patients in Latin America with severe left main coronary artery disease, the guideline panel suggests either PCI or CABG. This is a conditional recommendation, based on low certainty in the evidence (⨁⨁◯◯). It applies when both procedures are clinically and anatomically appropriate and can be performed at centers meeting acceptable standards. The decision should be made through a shared decision-making process involving the patient and the multidisciplinary care team.
dc.description.versionVersión publicada
dc.format.extent13 p.
dc.identifier.citationLamelas P, Pompeu Sá M, Izcovich A, Bottaro F, Tisi Baña M, Sosa Liprandi MI, Lanas F, Vilca Mejia OA, Zuñiga Luna M, Aubanel P, Munera A, Contreras Reyes J, Bagur R, Whitlock R, Garcia Garcia H, Mamas M, Cohen MG, Ricalde A, Abizaid A, Mendiz O, Araya M, Costa R, Santaera O, Hidalgo P, Caldonazo T, Baranchuk A, Ragusa MA; Endorsed by the Sociedad Latino Americana de Cardiología Intervencionista (SOLACI); Sociedad Interamericana de Cardiología (SIAC). Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline. Int J Cardiol. 2025 Oct 1;436:133401. doi: 10.1016/j.ijcard.2025.133401. Epub 2025 May 20. Erratum in: Int J Cardiol. 2025 Nov 1;438:133520. doi: 10.1016/j.ijcard.2025.133520. PMID: 40403850
dc.identifier.doihttps://doi.org/10.1016/j.ijcard.2025.133401
dc.identifier.urihttps://hdl.handle.net/11447/10915
dc.language.isoen
dc.subjectCABG
dc.subjectCAD
dc.subjectPCI
dc.titlePercutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline
dc.typeArticle
dcterms.accessRightsAcceso abierto
dcterms.sourceInternational Journal of Cardiology
dspace.entity.typePublication

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