The Contemporary Role of Percutaneous Coronary Intervention in Left Main Disease Management

Abstract

Since the 1980s coronary artery bypass grafting (CABG) has been considered as the gold standard for treating left main disease. The continuous evolution of tools and techniques concerning coronary angioplasty and the advent of drug-eluting stents (DES) have established percutaneous coronary intervention (PCI) as a possible alternative to CABG. Initial randomized studies that were conducted during the previous decade, with main representative the SYNTAX study, compared conventional CABG to PCI with first generation DES and showed non-inferiority regarding hard clinical outcomes. The results of two randomized studies comparing CABG versus PCI with second generation DES were simultaneously published in the end of 2016 to further support PCI as a credible alternative to CABG for patients with left main disease with low and intermediate SYNTAX scores. A Heart Team is indispensable to best evaluate the anatomic parameters of coronary lesions, the clinical variables and the technical possibilities regarding disease complexity in order to define the ideal revascularization strategy for each patient in the elective setting. Percutaneous treatment for left main disease has been increasingly performed during the last decade, since the procedural steps and optimal techniques for left main PCI are nowadays standardized and well described in expert consensus documents and therefore should be respected and applied in order to optimize patient outcomes. Rhythmos 2018;13(3):48-53.