Management of left main disease: An update

Jean Fajadet, Davide Capodanno, Gregg W. Stone

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations

Abstract

A severe narrowing of the left main coronary artery (LMCA), usually due to atherosclerosis, jeopardizes a large area of myocardium and increases the risk of major adverse cardiac events. Management strategies for LMCA disease include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). In general, PCI offers more rapid recovery and a lower early adverse event rate, whereas CABG offers a more durable procedure. The largest of six LMCA trials comparing PCI with CABG recently reported that in patients with site-reported low or intermediate anatomical complexity PCI was non-inferior to CABG with respect to the composite of death, stroke, or myocardial infarction at 3 years. This result was obtained on a background of contemporary PCI standards, including safer and more effective stents, intravascular imaging and physiology assessment. This review updates on the current management of LMCA disease, with an emphasis on clinical data and procedural knowledge supporting the use of PCI in a growing proportion of patients.

Original languageEnglish
Pages (from-to)1454-1465
Number of pages12
JournalEuropean Heart Journal
Volume40
Issue number18
DOIs
StatePublished - 1 May 2019
Externally publishedYes

Keywords

  • Coronary artery bypass grafting
  • Left main
  • Left main coronary artery
  • Percutaneous coronary intervention

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