title: Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery.
abstract: For coronary artery disease with unprotected left main stem (LMS) stenosis, coronary artery bypass grafting (CABG) is traditionally regarded as the "standard of care" because of its well-documented and durable survival advantage. There is now an increasing trend to use drug-eluting stents for LMS stenosis rather than CABG despite very little high-quality data to inform clinical practice. We herein: 1) evaluate the current evidence in support of the use of percutaneous revascularization for unprotected LMS; 2) assess the underlying justification for randomized controlled trials of stenting versus surgery for unprotected LMS; and 3) examine the optimum approach to informed consent. We conclude that CABG should indeed remain the preferred revascularization treatment in good surgical candidates with unprotected LMS stenosis.
authors.affiliation: Department of Cardiac Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. david.taggart@orh.nhs.uk
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kaul
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Paul T
authors.initials: PT
authors.lastname: Sergeant
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shemin
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D032962:Consent Forms; D001026:Coronary Artery Bypass / Q000009:adverse effects; D023903:Coronary Restenosis / Q000209:etiology*; D023921:Coronary Stenosis / Q000601:surgery / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006801:Humans; D016896:Treatment Outcome