Abstract
For several decades, coronary artery bypass grafting (CABG) has been considered as the gold standard treatment of unprotected left main coronary artery (LMCA) disease. However, because of large vessel caliber and anatomic accessibility, percutaneous coronary intervention (PCI) for LMCA has been attractive option for interventional cardiologists. With the marked improvement in technique and technology, PCI has been shown to be feasible for patients with unprotected LMCA stenosis. The recent introduction of drug-eluting stents (DESs), together with advances in pre procedural and post procedural adjunctive pharmacotherapies, has improved outcomes of PCIs of these lesions. The available current evidence comparing efficacy and safety of PCIs using DES and CABG revealed comparable results in terms of safety and a lower need for repeat revascularization for CABG. Still the management can be challenging in high risk anatomic subsets involving LMCA bifurcation lesions and, therefore, an integrated approach combining advanced devices, tailored techniques, adjunctive support of physiologic evaluation, and adjunctive pharmacologic agents should be reinforced to improve clinical outcome.
Highlights
Significant unprotected left main coronary artery disease (LMCA) is diagnosed in 5-10% patients undergoing coronary angiography [1,2]
SCAD= stable coronary artery disease; ACS= acute coronary syndrome; ESC= European Society of Cardiology; EATS= European Association for Cardio-Thoracic Surgery; ACCF= American College of Cardiology Foundation; AHA= American Heart Association; SCAI=Society for Cardiovascular Angiography and Intervention; LOE= Level of evidence; CAD= coronary artery disease; NC= not recommended by guidelines; SYNTAX= Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery; unstable angina (UA)/NSTEMI= Unstable angina/non-ST elevation myocardial infarction; ST-elevation myocardial infarction (STEMI)= ST elevation myocardial infarction; CABG= coronary artery bypass grafting
The results of this study suggest that the use of second-generation drug-eluting stents (DESs) is feasible, with similar outcomes to those noted with the use of firstgeneration DESs in ISAR-LEFT MAIN
Summary
Significant unprotected left main coronary artery disease (LMCA) is diagnosed in 5-10% patients undergoing coronary angiography [1,2]. Coronary artery bypass grafting (CABG) of LMCA lesion has shown significant benefit [3,4,5,6]. CABG has been the gold standard therapy for LMCA disease until recently. The interventional cardiologists have been emboldened to test the feasibility of percutaneous coronary intervention (PCI) of LMCA mainly as a result of improved technical advances and stent technology [7]
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