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Clinical Crossroads Update
October 3, 2007

Update: A 69-Year-Old Woman With Left Main Coronary Artery Disease

JAMA. 2007;298(13):1558-1559. doi:10.1001/jama.298.13.1558

In November 2004, Joseph Carrozza, MD, an interventional cardiologist, and Frank Sellke, MD, a cardiac surgeon, discussed the short and long-term clinical outcomes of interventions designed to manage coronary artery disease involving the left main artery.1 The patient, Mrs D, had multiple risk factors for coronary artery disease and was taking nitroglycerin as needed as well as clopidogrel. In late 2003, she developed sinus bradycardia and demonstrated distal anterolateral ischemia during a stress electrocardiogram. Cardiac catheterization revealed 60% to 70% stenosis of the left main coronary artery. Mrs D received conflicting advice on whether she should have a stenting procedure or coronary artery bypass graft (CABG) surgery.

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