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31 Aug 2009

GRACE left main study: unprotected left main revascularization in patients with acute coronary syndromes 

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Topics: Acute Coronary Syndromes (ACS)
Session number: 1846-1847
Session title: Unprotected left main revascularization in patients with acute coronary syndromes. GRACE left main study
Authors: Montalescot, Gilles - Hamm, Christian

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Presenter | see Discussant report

Gilles Montalescot

Gilles Montalescot (France)

Discussant | see Presenter abstract

Christian Hamm

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Christian Hamm, FESC (Germany)


In patients with acute coronary syndromes undergoing coronary angiography main stem lesions are found in approximately 5% of the cases. The treatment decision in this high risk subset is regularly difficult, because surgery in developing myocardial infarction is problematic and angioplasty technically demanding. Evidence for treatment decisions in such scenarios cannot be derived from randomised trials, but must come from carefully conducted registries.
In this context, the GRACE data provide valuable information for the management of these patients. It is self explaining that the mortality is high and the confounding factors are too complex to make conclusions with respect to the best treatment modality. The decision making has to be very individual and depends also on the local expertise and circumstances.
There is a strong trend over the observation period of 7 years to acutely perform more angioplasties and to delay surgery to following days. Therefore, these data reassure of what is currently done across the world and support the use of revascularisation techniques whatever and whenever feasible.

Notes to editor
This congress report accompanies a presentation given at the ESC Congress 2009. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.