Korean Circ J.  2023 Mar;53(3):113-133. 10.4070/kcj.2022.0333.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Revascularization of Left Main Coronary Artery Disease

• Park S
• Park SJ
• Park DW

• KMID: 2540391
• DOI: http://doi.org/10.4070/kcj.2022.0333

Abstract

Owing to a large-jeopardized myocardium, left main coronary artery disease (LMCAD) represents the substantial high-risk anatomical subset of obstructive coronary artery disease. For several decades, coronary artery bypass grafting (CABG) has been the “gold standard” treatment for LMCAD. Along with advances in CABG, percutaneous coronary intervention (PCI) has also dramatically evolved over time in conjunction with advances in the stent or device technology, adjunct pharmacotherapy, accumulated experiences, and practice changes, establishing its position as a safe, reasonable treatment option for such a complex disease. Until recently, several randomized clinical trials, meta-analyses, and observational registries comparing PCI and CABG for LMCAD have shown comparable long-term survival with tradeoffs between early and late risk-benefit of each treatment. Despite this, there are still several unmet issues for revascularization strategy and management for LMCAD. This review article summarized updated knowledge on evolution and clinical evidence on the treatment of LMCAD, with a focus on the comparison of state-of-the-art PCI with CABG.

Keyword

Coronary artery bypass grafting; Left main coronary artery disease; Percutaneous coronary intervention

Figure

• 

  Figure 1 Timelines of important milestones of PCI and CABG and landmark trials comparing PCI versus CABG for left main revascularization.BIMA = bilateral internal mammary artery; CABG = coronary artery bypass grafting; DES = drug-eluting stents; EXCEL = Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization; FDA = Food and Drug Administration; FFR = fractional flow reserve; IVUS = intravascular ultrasound; LAD = left anterior descending artery; LIMA = left internal mammary artery; LV = left ventricular; MIDCAB = minimally invasive direct coronary artery bypass; NOBLE = Nordic-Baltic-British left main revascularization; PCI = percutaneous coronary intervention; POBA = plain old balloon angioplasty; PRECOMBAT = Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease; RCA = right coronary artery; RCT = randomized clinical trial; RIMA = right internal mammary artery; SVG = saphenous vein graft; SYNTAX = Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery.

• 

  Figure 2 Optimal heart team approach for LMCAD revascularization.CABG = coronary artery bypass grafting; LMCAD = left main coronary artery disease; LVEF = left ventricular ejection fraction, MI = myocardial infarction; PCI = percutaneous coronary intervention; QoL = quality of life.

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