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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 Differences between the left main and other bifurcations 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) Impact of Staging Percutaneous Coronary Intervention in Left Main Artery Disease: Insights From the EXCEL Trial Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: 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 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 Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database 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
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Review Article2017 Oct 1;2(10):1089.

JOURNAL：JAMA Cardiol. Article Link

Left Main Revascularization in 2017: Coronary Artery Bypass Grafting or Percutaneous Coronary Intervention?

Kirtane AJ, Bonow RO. Keywords: CABG; PCI; left main revascularization

ABSTRACT

It can be argued that severe left main coronary artery (LMCA) disease represents the only anatomic subtype of coronary artery disease for which there is clear and unequivocal prognostic evidence in favor of coronary revascularization across the spectrum of clinical presentation—from stable ischemic heart disease to acute coronary syndrome. For decades, the standard approach to LMCA revascularization has been through coronary artery bypass grafting (CABG) given its ability to safely and effectively achieve complete revascularization. More recently, revascularization through percutaneous coronary intervention (PCI) has been proposed as an alternative to CABG for traditionally surgical anatomy. Predicate data from the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) clinical trial and other clinical trials have suggested that the LMCA may be ideally suited to maximize the potential relative benefits of PCI (less invasiveness, ideally suited for larger vessels with more focal disease) while mitigating its relative disadvantages (restenosis and stent thrombosis, especially when tackling diffuse disease). However, until recently, the prospective evidence base on which this assertion was based was limited.
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