Outcomes of patients with unprotected left main coronary artery disease

The available evidence supporting the treatment of patients with left main coronary artery disease (LMCA) in support of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains unascertained. Current clinical guidelines recommend PCI as an appropriate alternative to the standard treatment with CABG in patients with LMCA and low-to-intermediate anatomical complexity. Randomized clinical trials (RCTs) with long follow-up results have recently been published showing comparable results for the two procedures with more frequent need for repeat revascularization in patients treated with PCI. Additional data are required to overcome the limitation of sample size in individual RCTs, in comparing the primary clinical outcomes endpoints including death, stroke, myocardial infarction and need for revascularization, between the two treatment strategies. Since atherosclerotic disease is progressive in nature, assessment of the outcomes of coronary interventions at long-term follow-up should be highly desirable. The recent our meta-analysis clearly demonstrates comparable long-term clinical outcome for PCI compared with CABG treatment of patients with unprotected LMCA disease. Hard clinical outcomes, including mortality, were not different between the two treatment strategies but the higher need for repeat revascularization with the non-surgical procedure should be considered in the decision-making process. It is expected that with continuous development of better-quality stents, resulting in better arterial stability and tissue compatibility and lower need for repeat revascularization, PCI might become the established treatment for selected patients with LMCA disease.The findings of this meta-analysis, with the longest clinical follow-up currently available, suggest that the MACE rate and long-term survival of patients were comparable in patients receiving PCI or CABG for unprotected left main stem disease. However, the rate of repeat revascularization was higher in patients treated with PCI