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Bayesian Interpretation of the EXCEL Trial and Other Randomized Clinical Trials of Left Main Coronary Artery Revascularization Two-year outcomes of everolimus vs. paclitaxel-eluting stent for the treatment of unprotected left main lesions: a propensity score matching comparison of patients included in the French Left Main Taxus (FLM Taxus) and the LEft MAin Xience (LEMAX) registries Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial Usefulness of the SYNTAX score II to validate 2-year outcomes in patients with complex coronary artery disease undergoing percutaneous coronary intervention: A large single-center study Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis A Systematic Review and Meta-analysis What Is the Optimal Revascularization Strategy for Left Main Coronary Stenosis? Why NOBLE and EXCEL Are Consistent With Each Other and With Previous Trials Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study Long-term results after PCI of unprotected distal left main coronary artery stenosis: the Bifurcations Bad Krozingen (BBK)-Left Main Registry Current treatment of significant left main coronary artery disease: A review
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EditorialSeptember 2017, [Online First]

JOURNAL：JAMA Cardiol. Article Link

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

Ajay J. Kirtane, Robert O. Bonow Keywords: Revascularization; CABG; PCI

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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