For several decades, coronary artery bypass grafting has been regarded as the standard choice of revascularization for significant left main coronary artery (LMCA) disease. However, in conjunction with remarkable advancement of device technology and adjunctive pharmacology, percutaneous coronary intervention (PCI) offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected patients with LMCA disease. Several landmark randomized clinical trials showed that PCI with drug-eluting stents for LMCA disease is a safe option with similar long-term survival rates to coronary artery bypass grafting surgery, especially in those with low and intermediate anatomic risk. Although it is expected that the updated evidence from recent randomized clinical trials will determine the next guidelines for the foreseeable future, there are still unresolved and unmet issues of LMCA revascularization and PCI strategy. This paper provides a comprehensive review on the evolution and an update on the management of LMCA disease.
Keywords: BMS, bare-metal stent(s); CABG, coronary artery bypass grafting; CAD, coronary artery disease; DAPT, dual antiplatelet therapy; DES, drug-eluting stent(s); DK, double-kissing; FFR, fractional flow reserve; IVUS, intravascular ultrasound; LAD, left anterior descending artery; LCX, left circumflex artery; LMCA, left main coronary artery; LVEF, left ventricular ejection fraction; MACCE, major adverse cardiac or cerebrovascular events; MI, myocardial infarction; MLA, minimal lumen area; PCI, percutaneous coronary intervention; RCT, randomized clinical trial; coronary artery bypass grafting; iFR, instantaneous wave-free ratio; left main coronary artery disease; percutaneous coronary intervention.
© 2022 The Authors.