The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-4329
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2026
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Rafaeli I.R.

Sechenov First Moscow State Medical University

Pankov A.N.

Sechenov First Moscow State Medical University

Zhuravel V.V.

Sechenov First Moscow State Medical University

Kireeva A.Yu.

Sechenov First Moscow State Medical University

Sandodze T.S.

Sechenov First Moscow State Medical University

Semitko S.P.

Sechenov First Moscow State Medical University

Chernysheva I.E.

Sechenov First Moscow State Medical University

Ioseliani D.G.

Sechenov First Moscow State Medical University

Criteria for direct myocardial revascularization in patients with left main coronary artery stenosis

Authors:

Rafaeli I.R., Pankov A.N., Zhuravel V.V., Kireeva A.Yu., Sandodze T.S., Semitko S.P., Chernysheva I.E., Ioseliani D.G.

More about the authors

Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2026;19(1): 77‑83

DOI: 10.17116/kardio20261901177

Read: 267 times

Buy for 300₽
Contact the author
Table of contents

CRITERIA FOR DIRECT MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH LEFT MAIN CORONARY ARTERY STENOSIS
CRITERIA FOR DIRECT MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH LEFT MAIN CORONARY ARTERY STENOSIS

To cite this article:

Rafaeli IR, Pankov AN, Zhuravel VV, et al. Criteria for direct myocardial revascularization in patients with left main coronary artery stenosis. Russian Journal of Cardiology and Cardiovascular Surgery. 2026;19(1):77‑83. (In Russ.)
https://doi.org/10.17116/kardio20261901177

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
Recommended articles:
Strain echo­cardiography for perioperative asse­ssment of the left ventricle and left atrium in patients unde­rgoing coro­nary artery bypass surgery. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(3):269-279
Imme­diate resu­lts of coro­nary bypass grafting without touching the aorta in patients with multiple-vessel disease: a single-center retrospective study. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(3):280-285
Opti­mal cardioplegia for coro­nary artery bypass grafting in patients with heart failure: a randomized study. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(4):405-411
Predictors of acute kidney disease in patients with stable angina after coro­nary artery bypass grafting. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(4):412-417
Cognitive reha­bilitation technology using a combination of postural training and simu­ltaneous cognitive task in prevention of cognitive impairment after coro­nary artery bypass grafting. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(4):418-427
Intraoperative myocardial infa­rction or repe­rfusion syndrome? Features of ECG diagnostics. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(4):428-433
Sternal wound infe­ction after coro­nary artery bypass grafting using bila­teral inte­rnal thoracic artery: prevention and mana­gement. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(5):520-525
Cognitive impairment after major surgical operations. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(4-2):74-80
Factors dete­rmining the effe­ctiveness of various anti­thrombotic therapy regi­mens after coro­nary artery bypass surgery in patients with diffuse lesions and small diameter of coro­nary arte­ries: a 12-month prospective follow-up. Russian Cardiology Bulletin. 2025;(3):25-35
Computer cognitive training for prevention of postoperative cognitive dysfunction after simu­ltaneous coro­nary artery bypass grafting and caro­tid artery surgery: a pilot study. Russian Cardiology Bulletin. 2025;(3):54-61
Abstract:

OBJECTIVE

To determine the objective indications and long-term outcomes of direct myocardial revascularization taking into account anatomy of left main coronary artery (LMCA) lesion.

MATERIAL AND METHODS

We analyzed baseline coronary angiography (CAG) data from 723 patients with LMCA disease (stenosis ≥50%) and long-term CAG results (67+9 months) in 283 patients who underwent surgery between 2010 and 2023. Severity of coronary artery disease was assessed using the DEFINITION and Syntax Score criteria.

RESULTS

The most common location of lesion was distal LMCA stenosis involving the bifurcation (250 (88.3%) cases). Complete revascularization (rSS-0) was achieved in 97.2% of patients. Analysis of two coronary artery (CA) lesion classifications (DEFINITION vs. Syntax Score) revealed that 30.6% of patients with Syntax score <22 had complex LMCA lesion involving the bifurcation as defined by the DEFINITION classification. These lesions make adequacy and long-term effectiveness of endovascular intervention questionable and are an indication for direct revascularization, as well as vice versa. Satisfactory conduit function was demonstrated in 85.4% of cases in long-term period. Furthermore, patency of the left and right internal mammary arteries, as well as venous bypass grafts was 92.2%, 88.4%, and 81.7%, respectively.

CONCLUSION

The DEFINITION classification provides fundamentally important and comprehensive information on anatomy and topography of LMCA lesions. It may be included in descriptive examination program for patients with LMCA stenosis.

Keywords:

coronary artery bypass grafting
left main coronary artery disease
Syntax Score
DEFINITION

Authors:

Rafaeli I.R.

Sechenov First Moscow State Medical University

Pankov A.N.

Sechenov First Moscow State Medical University

Zhuravel V.V.

Sechenov First Moscow State Medical University

Kireeva A.Yu.

Sechenov First Moscow State Medical University

Sandodze T.S.

Sechenov First Moscow State Medical University

Semitko S.P.

Sechenov First Moscow State Medical University

Chernysheva I.E.

Sechenov First Moscow State Medical University

Ioseliani D.G.

Sechenov First Moscow State Medical University

Received:

17.02.2025

Accepted:

18.05.2025

Close metadata

References:

  1. Konigstein M, Redfors B, Zhang Z, et al. Utility of the ACC/AHA Lesion Classification to Predict Outcomes After Contemporary DES Treatment: Individual Patient Data Pooled Analysis From 7 Randomized Trials. Journal of the American Heart Association. 2022;11(24):e025275. https://doi.org/10.1161/JAHA.121.025275
  2. Noguchi M, Gkargkoulas F, Matsumura M, et al. Impact of Nonobstructive Left Main Coronary Artery Atherosclerosis on Long-Term Mortality. JACC: Cardiovascular Interventions. 2022;15(21):2206-2217. https://doi.org/10.1016/j.jcin.2022.08.024
  3. Tanyeli O. Left Main Coronary Artery Disease: Current Treatment Options. Edited by Aronow WS. 2017 Dec.  https://doi.org/10.5772/intechopen.71562
  4. Pellegrini D, Ielasi A, Tespili M, et al. Percutaneous Treatment of Left Main Disease: A Review of Current Status. J Clin Med. 2023;12(15):4972. https://doi.org/10.3390/jcm12154972
  5. Showkathali R, Yalamanchi RP. Contemporary Left Main Percutaneous Coronary Intervention: A State-of-the-art Review. Interv Cardiol. 2023:18:e20.  https://doi.org/10.15420/icr.2023.02
  6. Doenst T, Haverich A, Serruys P, Bonow RO, Kappetein P, Falk V, Velazquez E, Diegeler A, Sigusch H. PCI and CABG for Treating Stable Coronary Artery Disease: JACC Review Topic of the Week. J Am Coll Cardiol. 2019 Mar 05;73(8):964-976.  https://doi.org/10.1016/j.jacc.2018.11.053
  7. Bergmark BA, Morrow DA. Beyond the ISCHEMIA Trial: Revascularization for Stable Ischemic Heart Disease in Patients With High-Risk Coronary Anatomical Features. J Am Heart Assoc. 2021 Jan 05;10(1):e019974. https://doi.org/10.1161/JAHA.120.019974
  8. Urso S, Sadaba R, González-Martín JM, et al. Coronary surgery provides better survival than drug-eluting stent: A pooled meta-analysis of Kaplan- Meier-derived individual patient data. J Thorac Cardiovasc Surg. 2023 Mar 30:S0022-5223(23)00258-1.  https://doi.org/10.1016/j.jtcvs.2023.03.020
  9. Pedro Magro, Miguel Sousa-Uva. Left main stenosis: Can a consensus be reached? Rev Port Cardiol (Engl Ed). 2021 Aug;40(8):619-622.  https://doi.org/10.1016/j.repce.2021.07.032
  10. Granger CB, Krychtiuk KA, Gersh BJ. Personalizing Choice of CABG vs PCI for Multivessel Disease: Predictive Model Falls Short. J Am Coll Cardiol. 2022 Apr 19;79(15):1474-1476. https://doi.org/10.1016/j.jacc.2022.02.011.
  11. Chen S-L. DEFINITION criteria for left main bifurcation stenting — from clinical need to a formula. Asia Intervention. 2023 Mar 15; 9(1):20-24.  https://doi.org/10.4244/AIJ-D-22-00074
  12. Belash SA, Barbukhatti KO, Yakuba II, Shevchenko SS, Bogdan AP. Left main coronary artery bypass for isolated stenosis. Russian Journal of Cardiology and Cardiovascular Surgery. 2016; 9(4):77-80. (In Russ.). https://doi.org/10.17116/kardio20169477-80
  13. Barac YD, Witberg G, Assali A, Klempfner R, et al. The Clinical SYNTAX score predicts survival better than the SYNTAX score in coronary revascularization. J Thorac Cardiovasc Surg. 2024 Jan;167(1):164-173.e4.  https://doi.org/10.1016/j.jtcvs.2022.02.030
  14. Castaldi G, Vermeersch P, Zivelonghi C, Benedetti A Applicability of the EXCEL Trial Criteria to an All-Comers Real-World Cohort of Unprotected Left Main Percutaneous Coronary Intervention. Am J Cardiol. 2023 May 15;195:98-106.  https://doi.org/10.1016/j.amjcard.2023.01.024
  15. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE et. all. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Jan 18;79(2):e21-e129. https://doi.org/10.1016/j.jacc.2021.09.006
  16. Ragosta M. Left main coronary artery disease: importance, diagnosis, assessment, and management. Curr Probl Cardiol. 2015 Mar; 40(3):93-126.  https://doi.org/10.1016/j.cpcardiol.2014.11.003
  17. Davidson LJ, Cleveland JC, Welt FG, et al. A Practical Approach to Left Main Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Nov 29;80(22):2119-2134. https://doi.org/10.1016/j.jacc.2022.09.034
  18. Medina A, Suarez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006;59:183. 
  19. Wee SB, Ahn JM, Kang DY, Park SJ, Park DW. Contemporary State-of-the-Art PCI of Left Main Coronary Artery Disease. Circ Cardiovasc Interv. 2024 Nov;17(11):e014026. https://doi.org/10.1161/CIRCINTERVENTIONS.124.014026
  20. Mardanyan GV, Vartanyan EL, Puretsky MV, et al. Prognostic value of modified Syntax Score in high- and medium-risk patients with multiple-vessel coronary artery disease and involvement of the left main coronary artery. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(5):407-412. (In Russ.). https://doi.org/10.17116/kardio202114051407
  21. Ahmed TAN, Othman AAA, Demitry SR, Elmaghraby KM. Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease. BMC Cardiovasc Disord. 2024 Jan 23;24(1):68.  https://doi.org/10.1186/s12872-023-03657-2
  22. Utegenov RB, Khelimsky DA, Badoyan AG, Baranov AA, Gorgulko AP, Krestyaninov OV, Bessonov IS, Eraliev TK. Clinical outcomes of percutaneous coronary interventions in patients with bifurcation lesions of the left main coronary artery (results from the Multicenter Registry for the study of bifurcation intervention). Clinical and Experimental Surgery. Petrovsky Journal. 2023;11(2): 24-33. (In Russ.). https://doi.org/10.33029/2308-1198-2023-11-2-24-33
  23. Rafaeli IR, Kireeva AI, Tsereteli NV, Rogatova AN, Semitko SP, Ioseliani DG. The influence of baseline severity of Coronary Artery Lesion (by the Syntax Score) on the Midterm Prognosis of Patients With Acute Myocardial Infarction Without ST Segment Elevation. Kardiologiia. 2022;62(11):19-25. (In Russ.). https://doi.org/10.18087/cardio.2022.11.n1984
  24. Sung W-T, Chuang M-J, Tsai Y-L, Chou R-H, Chang C-C, Huang P-H. Impacts of the SYNTAX score I, II and SYNTAX score II 2020 on left main revascularization. Sci Rep. 2024 Jan 11; 14(1):1073. https://doi.org/10.1038/s41598-024-51192-7
  25. Gao C, Li D, Dai H, Liu H, Liu P, Cheng M, Zhang M, Guo W. Review of Progress in Interventional Therapy for Coronary Bifurcation Lesions. Rev Cardiovasc Med. 2024 Jan 4;25(1):2. PMID: 39077661; PMCID: PMC11262401. https://doi.org/10.31083/j.rcm2501002
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.