Korean Circ J.  2019 May;49(5):369-383. 10.4070/kcj.2019.0112.

Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting for the Treatment of Left Main Coronary Artery Disease

• Cho SC
• Park DW
• Park SJ

• KMID: 2444958
• DOI: http://doi.org/10.4070/kcj.2019.0112

Abstract

Severe stenosis of the left main coronary artery (LMCA) generally occurs as a result of atherosclerosis and compromises the blood supply to a wide area of myocardium, thereby increasing the risk of serious adverse cardiac events. Current revascularization strategies for patients with significant LMCA disease include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), both of which have a range of advantages and disadvantages. In general, PCI is associated with a lower rate of periprocedural adverse events and provides more rapid recovery, while CABG provides more durable revascularization. Most clinical trials comparing PCI and CABG for the treatment of LMCA disease have shown PCI to be non-inferior to CABG with respect to mortality and the serious composite outcome of death, myocardial infarction, or stroke in patients with low-to-intermediate anatomical complexities. Remarkable advancements in PCI standards, including safer and more effective stents, adjunctive intravascular imaging or physiologic evaluation, and antithrombotic treatment, may have contributed to these favorable results. This review provides an update on the current management of LMCA disease with an emphasis on clinical data and academic and clinical knowledge that supports the use of PCI in an increasing proportion of patients with LMCA disease.

Keyword

Coronary artery disease; Percutaneous coronary intervention; Coronary artery bypass; Angioplasty, balloon, coronary; Drug-eluting stents; Treatment outcome

MeSH Terms

Angioplasty, Balloon, Coronary
Atherosclerosis
Constriction, Pathologic
Coronary Artery Bypass*
Coronary Artery Disease*
Coronary Vessels*
Drug-Eluting Stents
Humans
Mortality
Myocardial Infarction
Myocardium
Percutaneous Coronary Intervention*
Stents
Stroke
Treatment Outcome

Figure

• 

  Figure 1 Heart team approach for LMCA revascularization. Figure adapted with permission from Park et al.48) CABG = coronary artery bypass grafting; CTO = chronic total occlusion; EF = ejection fraction; DAPT = dual antiplatelet therapy; LM = left main; MI = myocardial infarction; MVD = multivessel disease; PCI = percutaneous coronary intervention.

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