Tuesday, May 02, 2006

Lessons from Korea

This meeting was again all about "drug-eluting stents" and the Korean specialty of "unprotected left main coronary artery ( ULMCA )" stenting. As we all know, the left main coronary artery is probably the most important artery bringing blood to the heart muscle. It supplies about two thirds, to three quarters of the blood supply to the heart (in some patients with a non-dominant right heart artery, this percentage can become almost 90%). Any acute blockage of this artery, usually means acute shock and probably death.

The present day understanding (historical practice guidelines drawn up initially by the Americans and Europeans) is that patients with significant disease of the ULMCA should be treated by surgery, in part because earlier results of angioplasty (plain old balloon angioplasty or bare metal stenting) of the ULMCA, resulted in a high rate of re-narrowing of the ULMCA and also a high chance of sudden cardiac death.

The Koreans have led the world by accumulating a huge experience in ULMCA stenting with very good results. The only other group whose results were almost as good were the French. Somehow, the Americans were unable to match the Koreans in this aspect (the recent results out of Scripps by Paul Terstein and presented at the TCT). So the Koreans are leading the world in trying to study this question of treatment of ULMCA disease. Is stenting of the ULMCA with the cypher (sirolimus eluting stent) better or is CABG better. Well, this evolutionary type study may help to change practice patterns. The study is just being organised and I suspect that it may need one or two years before any meaningful results are available. The Koreans are really leading the world in this. I must say that they are very organised and good. There is quite a large field of experts and delegates here, and it is certainly a privilege to be a member of the international guest faculty.

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