title: Role of percutaneous coronary intervention in the treatment of left main coronary artery disease.
abstract: Revascularization with coronary artery bypass graft surgery is the choice of therapy in patients with left main (LM) coronary artery stenosis. During the last decade, the introduction of drug-eluting stents, together with antiplatelet and antithrombotic treatments, has improved the outcome of percutaneous coronary interventions (PCIs) by reducing the number of repeat revascularizations and the risk of stent thrombosis. Many institutions inside and outside the United States have adopted stent treatment of unprotected LM coronary artery disease as a more routine strategy. However, coronary bypass surgery has improved as well by using more arterial grafts, better perioperative care, and optimizing medical treatment postoperatively. The advances in stent technique may reduce the gap between coronary surgery and PCIs further, but the results of the Evaluation of Xience Prime versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization study, randomizing patients with LM coronary artery disease between coronary bypass grafting and PCIs, will be needed to test whether PCIs is noninferior to coronary bypass surgery.
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.. Electronic address: kappetein@erasmusmc.nl.
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Head
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ruben L J
authors.initials: RL
authors.lastname: Osnabrugge
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: van Mieghem
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Coronary bypass surgery; Left main disease; Percutaneous coronary intervention; Revascularization