{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:11:24Z","timestamp":1789539084697,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The majority of randomized controlled trials of revascularization decision-making excludes left main coronary artery disease (LMD). Therefore, contemporary clinical outcomes of patients with stable coronary artery disease and LMD with proven ischemia remain poorly understood. The aim of this study was to assess the long-term clinical outcomes of physiologically significant LMD according to the treatment strategies of revascularization versus revascularization deferral.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>In this international multicenter registry of stable LMD interrogated with the instantaneous wave-free ratio, patients with physiologically significant ischemia (instantaneous wave-free ratio \u22640.89) were analyzed according to the coronary revascularization (n=151) versus revascularization deferral (n=74). Propensity score matching was performed to adjust for baseline clinical characteristics. The primary end point was a composite of death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization of left main stem. The secondary end points were as follows: cardiac death or spontaneous LMD-related myocardial infarction; and ischemia-driven target lesion revascularization of left main stem.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              At a median follow-up period of 2.8 years, the primary end point occurred in 11 patients (14.9%) in the revascularized group and 21 patients (28.4%) in the deferred group (hazard ratio, 0.42 [95% CI, 0.20\u20130.89];\n              <jats:italic>P<\/jats:italic>\n              =0.023). For the secondary end points, cardiac death or LMD-related myocardial infarction occurred significantly less frequently in the revascularized group (0.0% versus 8.1%;\n              <jats:italic>P<\/jats:italic>\n              =0.004). The rate of ischemia-driven target lesion revascularization of left main stem was also significantly lower in the revascularized group (5.4% versus 17.6%; hazard ratio, 0.20 [95% CI, 0.056\u20130.70];\n              <jats:italic>P<\/jats:italic>\n              =0.012).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>In patients who underwent revascularization for stable coronary artery disease and physiologically significant LMD determined by instantaneous wave-free ratio, the long-term clinical outcomes were significantly improved as compared with those in whom revascularization was deferred.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.122.012700","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T18:01:40Z","timestamp":1687284100000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7504-409X","authenticated-orcid":true,"given":"Takayuki","family":"Warisawa","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan (T.W., S.D., Y.J.A.)."},{"name":"Department of Cardiology, NTT Medical Center Tokyo, Japan (T.W.)."},{"name":"National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5390-8851","authenticated-orcid":true,"given":"Christopher M.","family":"Cook","sequence":"additional","affiliation":[{"name":"The Essex Cardiothroacic Centre, UK (C.M.K.)."},{"name":"Anglia Ruskin University, Essex, UK (C.M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1364-8055","authenticated-orcid":true,"given":"Yousif","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (Y.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9989-6331","authenticated-orcid":true,"given":"James P.","family":"Howard","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)."},{"name":"Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4244-860X","authenticated-orcid":true,"given":"Henry","family":"Seligman","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)."},{"name":"Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0086-1113","authenticated-orcid":true,"given":"Christopher","family":"Rajkumar","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, UK (T.W., J.P.H., H.S., C.R., Y.K., R.A.-L., S.S., J.E.D.)."},{"name":"Cardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK (J.P.H., H.S., C.R., R.A.-L., S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4681-2798","authenticated-orcid":true,"given":"Takumi","family":"Toya","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Defense Medical College, Tokorozawa, Japan (T.T.)."},{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (T.T., A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Doi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan (T.W., S.D., Y.J.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8024-9620","authenticated-orcid":true,"given":"Masafumi","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Gifu Heart Center, Japan (M.N., Y.K., H.M.)."},{"name":"Cardiovascular Center, Toda Central General Hospital, Japan (M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3806-4953","authenticated-orcid":true,"given":"Rafael","family":"Vera-Urquiza","sequence":"additional","affiliation":[{"name":"Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Spain (R.V.-U., S.Y., J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonoka","family":"Yuasa","sequence":"additional","affiliation":[{"name":"Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Spain (R.V.-U., S.Y., 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