Myocardial Revascularization in Patients With Left Main Coronary Disease

Eirini Apostolidou, MD; Deepika Kalisetti, MD; Sachin Logani, MD; Daniel J. McCormick, DO; Sheldon Goldberg, MD


J Invasive Cardiol. 2013;25(4):201-207. 

In This Article

Abstract and Introduction


While coronary artery bypass grafting (CABG) has been the standard of care for patients with unprotected left main coronary artery disease, advances in percutaneous coronary intervention (PCI) have made stent placement a reasonable alternative in selected patients. In this review, we address the results of studies comparing PCI with CABG, discuss the invasive evaluation of these patients, and the technical approach to percutaneous revascularization. Furthermore, we discuss future pivotal trials, which will help define long-term outcomes comparing PCI with surgery.


Significant left main disease (LMD), defined as a stenosis of ≥50%, is found in association with multi-vessel coronary artery disease (CAD) in 75%-90% of patients and occurs in 3%-5% of patients undergoing coronary angiography.[1] Left main (LM) lesions are classified as either protected or unprotected. Patients with prior coronary artery bypass graft (CABG) or a patent graft to either the left anterior descending (LAD) artery or left circumflex (LCX) are considered protected. Since the circulation from the LM supplies 75% of the left ventricle (LV), occlusion of this vessel may lead to extensive myocardial loss and death. While CABG has long been considered the standard for revascularization in patients with LMD,[2] recent studies have suggested that percutaneous coronary intervention (PCI) may be a safe and effective alternative in this high-risk group.

In this report, we will review current data regarding surgical versus percutaneous revascularization in patients with unprotected left main disease (ULMD) and discuss the evolving role of PCI.