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.

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Seminars in Thoracic and Cardiovascular Surgery
Department of Cardio-Thoracic Surgery

Kappetein, A. P., Head, S., Osnabrugge, R., & van Mieghem, N. (2014). Role of Percutaneous Coronary Intervention in the Treatment of Left Main Coronary Artery Disease. Seminars in Thoracic and Cardiovascular Surgery (Vol. 26, pp. 187–191). doi:10.1053/j.semtcvs.2014.09.004