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

Lamelas, Pablo; Pompeu Sá, Michel; Izcovich, Ariel; Bottaro, Federico; Tisi Baña, Matias; Sosa Liprandi, Maria Ines; Lanas, Fernando; Vilca Mejia, Omar Asdrúbal; Zuñiga Luna, Mauricio; Aubanel, Patricia; Munera, Ana; Contreras Reyes, Juan; Bagur, Rodrigo; Whitlock, Richard; Garcia Garcia, Hector; Mamas, Mamas; Cohen, Mauricio G; Ricalde, Alejando; Abizaid, Alexandre; Mendiz, Oscar; Araya, Mario; Costa, Ricardo; Santaera, Omar; Hidalgo, Pedro; Caldonazo, Tulio; Baranchuk, Adrian; Ragusa, Martín Alberto

Abstract

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. 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. 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. 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. [Abstract copyright: Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.]

Citation

Lamelas, P., Pompeu Sá, M., Izcovich, A., Bottaro, F., Tisi Baña, M., Sosa Liprandi, M. I., Lanas, F., Vilca Mejia, O. A., Zuñiga Luna, M., Aubanel, P., Munera, A., Contreras Reyes, J., Bagur, R., Whitlock, R., Garcia Garcia, H., Mamas, M., Cohen, M. G., Ricalde, A., Abizaid, A., Mendiz, O., …Ragusa, M. A. (2025). Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline. International Journal of Cardiology, 436(1 October 2025), Article 133401. https://doi.org/10.1016/j.ijcard.2025.133401

• Journal Article Type: Article
• Acceptance Date: May 16, 2025
• Online Publication Date: May 20, 2025
• Publication Date: May 20, 2025
• Deposit Date: Jun 9, 2025
• Journal: International journal of cardiology
• Print ISSN: 0167-5273
• Electronic ISSN: 1874-1754
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 436
• Issue: 1 October 2025
• Article Number: 133401
• DOI: https://doi.org/10.1016/j.ijcard.2025.133401
• Keywords: CABG, PCI, CAD
• Public URL: https://keele-repository.worktribe.com/output/1276809
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0167527325004449?via%3Dihub