Heart Care Info - Heart Disease Prevention & Treatment

... Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery ( ...

MC Morice - Circulation, 2011 - Am Heart Assoc We thank Dr Uretsky for his interest in our study. 1 He is correct that 248 of 705 patients who were visually assessed as having distal left main (LM) bifurcation disease by the site's Heart Team (interventional cardiologist, cardiothoracic surgeon, and study coordinator) were ...

Response to Letter Regarding Article, “Outcomes in Patients With De Novo Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) Trial”

We thank Dr Uretsky for his interest in our study.1 He is correct that 248 of 705 patients who were visually assessed as having distal left main (LM) bifurcation disease by the site's Heart Team (interventional cardiologist, cardiothoracic surgeon, and study coordinator) were later determined by the core laboratory to not strictly meet the study protocol definition of LM disease (eg, the patients were determined to have B- [Medina type 0,1,0]- or E- [Medina type 0,0,1]-type distal LM bifurcation lesions). This discrepancy between the site and core laboratory determinations is typical of clinical trials that use a core laboratory for standardization. We have not separately assessed outcomes excluding those patients whom the core laboratory did not deem to have LM disease because, on an intent-to-treat basis, study investigators treated them as having LM disease.

Because it is likely that clinicians will treat this group as having LM disease in the future, subanalysis of outcomes in this group, as Dr Uretsky suggests, is a good idea. We agree with Dr Uretsky that visual assessment of lesions identified by angiography does have limitations. We also agree that increased use of other techniques (such as fractional flow reserve, optical coherence tomography, or intravascular ultrasound) will aid in making appropriate treatment decisions in this patient population, and that increased use of these techniques should be encouraged. However, in clinical practice, most patients are treated by surgery or percutaneous coronary intervention without any additional evaluation. In this regard, we look forward to the results ...