Left Main Disease PCI vs CABG: A Brief Review of Important Literature

Abstract

Left main coronary artery (LMCA) disease is defined as > 50% narrowing of vessel diameter; it is the disease of significant morbidity and mortality because it supplies 75% of the left ventricle, so any insult to the left main can lead to severe LV dysfunction, sudden cardiac arrest and arrhythmia. The incidence of left main disease in patients undergoing coronary angiography is 4-6%. The untreated left main disease has mortality around 20% at 1 year [1,2].Initially, the procedure of choice for the significant left main disease was coronary artery by-pass surgery (CABG), as medical therapy carries a high mortality rate as compared to CABG (36.5% vs 16.0%). Nevertheless, with the advancement in percutaneous intervention (PCI), there is a growing interest and passion in the percutaneous intervention of LMCA [3]. European [4] and American [5] guidelines recommend CABG (class I) as the treatment method of choice for LMCA in patients with all anatomical complexities. Current European treatment guidelines give PCI class I along with CABG if SYNTAX score < 22, class IIa if between 23-32, and class III (Harm) if SYNTAX > 33. Current US guidelines currently gives class IIa recommendation for PCI if syntax score is low, class IIb for a score between 23-32 and similar to European guideline's class III (Harm) for SYNTAX score > 33. We reviewed the major landmark trials that compare PCI vs CBAG as a treatment option for left main disease along with important meta-analysis