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Impact of coronary anatomy and stenting technique on long-term outcome after drug-eluting stent implantation for unprotected left main coronary artery disease Comparison of Outcomes of Percutaneous Coronary Intervention on Native Coronary Arteries Versus on Saphenous Venous Aorta Coronary Conduits in Patients With Low Left Ventricular Ejection Fraction and Impella Device Implantation Achieved or Attempted (from the PROTECT II Randomized Trial and the cVAD Registry) Differences between the left main and other bifurcations Impact of Staging Percutaneous Coronary Intervention in Left Main Artery Disease: Insights From the EXCEL Trial Comparative effectiveness analysis of percutaneous coronary intervention versus coronary artery bypass grafting in patients with chronic kidney disease and unprotected left main coronary artery disease Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial Percutaneous Coronary Intervention of Left Main Disease: Pre- and Post-EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) Era Contemporary Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention in the United States: An Analysis of the National Cardiovascular Data Registry Research to Practice Initiative Impact of chronic obstructive pulmonary disease on prognosis after percutaneous coronary intervention and bypass surgery for left main coronary artery disease: an analysis from the EXCEL trial New-onset atrial fibrillation after PCI and CABG for left main disease: insights from the EXCEL trial and additional studies
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Review Article2018 Nov 20. [Epub ahead of print]

JOURNAL：Cardiovasc Revasc Med. Article Link

Revascularization of left main coronary artery

Baydoun H, Jabbar A, Nakhle A et al. Keywords: Left main coronary artery ; CABG; PCI; IVUS-guidance; high surgical risk; DES; atherectomy techniques;

ABSTRACT

Highlights

  • - CABG is still the preferred way to treat patients with unprotected left main disease (UPLMD).
  • - PCI is a reasonable approach mainly in patients with high surgical risk and non-complex anatomy (Syntax score <33).
  • - IVUS-guided PCI is associated with lower risks of all-cause death, cardiac death, TVR and in-stent thrombosis.
  • - FFR is feasible but less validated than IVUS for LM disease and should be used in correlation with IVUS.
  • - DK crush is favored over other techniques for true distal LM bifurcation with lower rates of MI, stent thrombosis and TLR.


Left main coronary artery (LMCA) disease affect 5-7% of patient undergoing coronary angiography and is associated with multivessel CAD in 70% of the cases. Untreated significant LMCA disease is associated with significant mortality and morbidity. CABG is the traditional therapy for revascularization in LMCA disease. PCI is a reasonable alternative mainly in patients with high surgical risk or other specific factors. Drug-eluting stents, improved antiplatelet therapeutic options, atherectomy techniques, IVUS-guidance and improved operator experience have all contributed to the observed improvement in clinical outcomes. Given the large number of variables involved in deciding between PCI and CABG, a heart team should make decisions regarding revascularization of LMCA disease.

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