Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: The Clinical Crossroads article
by Drs Carrozza and Sellke1 addresses the therapeutic
options for a 69-year-old woman with disease of the left main coronary artery.
Their discussion reflects state-of-the-art approaches2 ;
promoting these surgical interventions rests on the assumption of the therapeutic
inferiority of medical management. However, the medical vs surgical management
studies were largely conducted in the 1970s and 1980s, well before aggressive
medical therapies were used for management of ischemia (eg, optimizing nitrates, β-blockers,
platelet inhibitors, and calcium channel blockers) or risk factor reduction
(especially the present ability to dramatically reduce cholesterol levels).3 Current aggressive management of lipid levels leads
to reduction of cardiovascular events within 6 months of initiating therapy.4,5 It would therefore be prudent to temper
the therapeutic suggestions in this case with the caveat that the efficacy
of current optimal medical management in disease of the left main coronary
artery is unknown.
Modest GA. Medical vs Surgical Management of Left Main Coronary Artery Disease. JAMA. 2005;293(9):1060-1061. doi:10.1001/jama.293.9.1060-b