Left Main Disease: The Last Frontier for Medical Therapy in Stable Coronary Artery Disease?
Bibliographic record
Abstract
Patients with stable coronary artery disease (CAD) involving ≥50% stenosis in the left main coronary artery almost invariably undergo revascularisation. However, there is lack of evidence from contemporary randomised controlled clinical trials (RCTs) supporting the superiority of this approach versus an initial strategy of intensive, multifaceted optimal medical therapy (OMT) directed at dyslipidaemic, hypertensive, thrombotic, metabolic and ischaemic targets. Current clinical practice guidelines still base their recommendations on small subsets of RCTs conducted in the 1970s and early 1980s. Given the lack of survival benefit among patients with stable, multi-vessel coronary artery disease who do versus those do not undergo routine revascularisation in the era of advanced OMT, the question arises whether the current treatment recommendations for left main disease are valid. This issue is of considerable importance; while significant left main disease is found in only 8-10% of diagnostic invasive angiography cases, it is a disease entity associated with a high risk of adverse clinical events and extensive resource use. This article discusses clinical trials data as well as challenges to address this question in the contemporary era. It highlights the complexities of trial planning and execution as it relates to both feasibility and equipoise, study design, choice of trial endpoints and duration of follow-up. The authors conclude there is a compelling need for an RCT to test the hypothesis that the current practice of routine revascularisation for all patients with LMD is superior to an initial strategy of multifaceted OMT with selective use of revascularisation.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".