Current Status and Future Perspective of Left Main Coronary Intervention

Park, Seung Jung; Park, Duk Woo

Abstract

For several decades, based on clinical trials comparing coronary-artery bypass grafting (CABG) with medical therapy, bypass surgery has been regarded as the treatment of choice for patients with unprotected left main coronary artery (LMCA) disease. However, because of marked advancements in techniques of percutaneous coronary intervention (PCI) with stenting and CABG and adjunctive pharmacologic therapy, new evaluation and a review of current indications for optimal revascularization therapy for LMCA disease may be required to determine the standard of care for these patients. The available current evidence suggests that the composite outcome of death, myocardial infarction and stroke is similar in patients with LMCA disease who are treated with PCI with stenting or CABG, only difference was the rate of repeat revascularization. Cumulative and emerging data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to select PCI with stenting as an alternative revascularization strategy for such patients. In addition, these data may change future guidelines and support the need for prospective, large randomized trials comparing the two revascularization treatment. Finally, these evidence will change the current clinical practice of revascularization strategy for unprotected LMCA disease.