CARDIAC CATH LAB - Mount Sinai Hospital

INNOVATIONS
Samin K. Sharma, MD
Director, Cardiac Cath Lab & Intervention, on
Complex Coronary Interventions
Live footage of
interventions,
including ULM
procedures, can
be viewed at
www.ccclivecases.org.
Mount Sinai Hospital’s cath lab ranks
as the top-volume PCI center in New
York State, based on Department of
Health statistics. The cath lab has
seen total interventions rise by 12
percent in the past year, coupled with
further declines in already low rates
of death and major complications.
These are statistics to be proud of
indeed! We can attribute our success
to the constant efforts on the part
of every member of our staff in
advancing clinical practice through
well-designed innovations. Below are brief descriptions of three such
recent innovations that are contributing both to improved
understanding of CAD and to patient outcomes after intervention.
Unprotected Left Main Disease
Historically, CABG had been the treatment of choice for unprotected
left main (ULM) disease, supported by the ACC/AHA guidelines. Even
recommendations updated in 2007 called PCI “consistently not helpful
and possibly harmful” in treating ULM cases. In the era of bare metal
stents, patients with ULM disease treated by PCI definitely did not do
as well over the long term as patients who underwent CABG. Since the
introduction of drug-eluting stents (DES), however, the use of PCI has
been expanded for selected patients with ULM lesions. There was a lack
of large, randomized studies to provide sufficient clinical data upon
which to make changes in the practice guidelines and make the use
of PCI broadly acceptable for ULM revascularization. The SYNTAX Trial
was designed to examine that premise, comparing CABG with thee
TAXUS® DES. In sum, the 1,800 patients who participated in the trial
had complex multivessel disease including a subset of 705 patients
with ULM disease. When the SYNTAX trial results were analyzed they
16 Mount Sinai Hospital Cardiac Cath Lab