Left main trunk coronary artery disease is a serious life-threatening condition which require proper medical treatment. This time we have reviewed randomized control trial comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). In four major study (EXCEL, NOBLE, SYNTAX, and PRECOMBAT), revascularization rate was more frequent in PCI. However, rate of myocardial infarction (MI) was different on each study, probably because the difference of definition of MI. Meta-analysis using individual patient data, the occurrence of MI during follow-up and the necessity of coronary revascularization were significantly higher in the PCI group compared to the CABG group.

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Objective: The aim of this study was to investigate the prognostic nutritional index (PNI) as a predictor of postoperative outcome after primary isolated coronary artery bypass grafting (CABG). Materials and methods: This retrospective cohort study included 164 patients who underwent primary isolated CABG. We assessed PNI and other nutritional parameters, and then examined the relationship with the postoperative outcome. To further evaluate the clinical significance of PNI, we also attempted to detect the PNI cut-off value for predictions. Results: Evaluation of the relationships between postoperative outcome and nutritional parameters assessed by using multivariable logistic or non-linear regression models showed that PNI was the only parameter that had a significant relationship with all of the postoperative complications (OR: 0.54, 95%CI: 0.30–0.97, p=0.012), the length of intensive care unit (ICU) stay (p=0.011), and the length of postoperative hospitalization (p=0.004). There was a significant difference for the postoperative complication (p<0.001), length of ICU stay (p=0.010) and length of postoperative hospitalization (p=0.004) between the two groups when divided by the 45.45 cut-off point. Conclusion: There was a significant relationship between PNI and postoperative outcome after primary isolated CABG. Preoperative nutritional assessment when using a PNI cut-off value of 45.45 might be a predictor.

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It is rare to detect single coronary arteries during angiography and rarer still to detect abnormal origins of the right coronary artery (RCA) from the left anterior descending artery (LAD). A 49-year-old man with hypertension and hyperlipidemia presented to our hospital with a chief complaint of exertion-induced chest pain in the month leading up to presentation. Inverted T-waves were seen in leads V1–V5 on the electrocardiogram, and coronary computed tomography (CT) demonstrated that all three major coronary arteries originated from the same ostium in the left sinus of Valsalva. An anomalous RCA arose from the LAD as a separate branch and then coursed anteriorly down the right atrioventricular groove. Coronary angiography showed a high-grade stenosis (>90%) in the proximal LAD and mid-distal RCA. The cardiology team discussed the treatment plan and consequently performed complete revascularization with percutaneous coronary intervention (PCI). The approach was successful, and at the 10-month follow-up, the patient was symptom-free and coronary CT showed no restenosis.

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Nonsurgical transvenous removal of perforating leads after pacemaker implantation is relatively safe but can lead to fatal complications, i.e., cardiac tamponade. Therefore, conducting this procedure with surgical backup support has been recommended. On the other hand, invasive surgical extraction has the advantage of being able to safely repair the perforation site while checking damage to adjacent structures under direct visualization as compared with nonsurgical extraction. Therefore, surgical repair should be considered in patients at a high risk of bleeding and potential damage to adjacent structures by pericardial penetration. We illustrate a case in which development of cardiac tamponade was avoided successfully by surgical direct visualization in a high-risk patient of bleeding.

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