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March 2, 2005

Medical vs Surgical Management of Left Main Coronary Artery Disease

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(9):1060-1061. doi:10.1001/jama.293.9.1060-b

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.

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