eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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2/2024
vol. 21
 
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abstract:
Review paper

Left main coronary artery disease: percutaneous coronary intervention or coronary artery bypass grafting? A critical review of current knowledge and contemporary debates

Ioannis Panagiotopoulos
1
,
Francesk Mulita
2
,
Georgios-Ioannis Verras
2
,
Eleni Bekou
3
,
Admir Mulita
3
,
Manfred Dahm
4
,
Konstantinos Grapatsas
5
,
Assaf Sawafta
6
,
Anastasia Katinioti
,
Elias Liolis
7
,
Christos Pitros
8
,
Levan Tchabashvili
9
,
Konstantinos Tasios
2
,
Andreas Antzoulas
2
,
Spyros Papadoulas
9
,
Efstratios Koletsis
1
,
Vasileios Leivaditis
4

  1. Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, Greece
  2. Department of Surgery, General University Hospital of Patras, Patras, Greece
  3. Medical Physics Department, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
  4. Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
  5. Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen Essen, Germany
  6. Department of Cardiology, University Hospital of Larissa, Larissa, Greece
  7. Cardiology Department, Elpis General Hospital, Athens, Greece
  8. Department of Oncology, General University Hospital of Patras, Patras, Greece
  9. Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
Kardiochirurgia i Torakochirurgia Polska 2024; 21 (2): 108-112
DOI: https://doi.org/10.5114/kitp.2024.141149
Online publish date: 2024/07/07
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Significant unprotected left main (ULM) disease is the highest-risk coronary artery lesion, carries high morbidity and mortality related to a large amount of myocardium supplied, and should undergo prompt revascularization. Among recent randomized controlled trials (RCTs), NOBLE failed to demonstrate non-inferiority of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). However, all the other RCTs have shown comparable outcomes. While CABG is associated with higher stroke rates at 30 days and 1 year, PCI is associated with increased spontaneous myocardial infarction (MI) events and the need for repeat revascularization. Furthermore, the benefit of CABG is more evident with the increased complexity of coronary artery disease. In current European and American guidelines, CABG is the standard of care for ULM disease. PCI is considered a reasonable alternative in selected patients (2a B-NR). There is still a great need for carefully designed RCTs with longer follow-up times to validate the role of recent technological and pharmacological regimens.
keywords:

coronary artery bypass grafting, percutaneous coronary intervention, left main coronary artery disease, contemporary debates
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