Critical lesion of the unprotected left main coronary disease carries a tremendous mortality burden, often associated with a diabetes status or multivessel disease, with coronary artery bypass grafting being the standard treatment for over 40 years. Percutaneous coronary intervention with drug eluting stents should be taken into consideration and could be a better option for patients with low SYNTAX score as validated by the recently published studies. This review summarizes the major randomized clinical trials and meta-analyses concerning the debate regarding percutaneous coronary intervention with drug eluting stents versus coronary artery bypass grafting for unprotected left main coronary disease, along with the latest European and American revascularization guidelines and tries to shed light on this matter. The most results advocate that there is no convincing difference in survival rate for both therapies, especially in patients with isolated left main disease but with fewer major ischemic events for coronary artery bypass grafting when compared with percutaneous coronary intervention in multivessel coronary artery disease, at the rate of a higher stroke incidence. The gaps in evidence are also highlighted, especially the lack of randomized clinical trials with new generation drug eluting stents versus coronary artery bypass grafting or those regarding the best revascularization strategy for an acute coronary syndrome when unprotected left main coronary disease is involved.
Cite this article
Coronary artery bypass graft surgery versus percutaneous coronary intervention in unprotected left main coronary artery disease: A systematic review
Liviu Macovei1,2, Robert Magopet1,*, Ana Tanasa1,2, Cezara Raileanu1, Cristina Prisacariu1,2, Mihai Razvan Presura3, Mircea Ovanez Balasanian1,2
1 Institute of Cardiovascular Diseases “Prof. dr. George I.M. Georgescu”, Iasi 700503, Romania
2 University of Medicine and Pharmacy “Grigore T. Popa”, Iasi 700115, Romania
3 Cardiology Clinic of Piatra Neamt General Hospital, Neamt 610136, Romania
*Correspondence: email@example.com (Magopet Robert)
Rev. Cardiovasc. Med. 2020, 21(1), 65–73; https://doi.org/10.31083/j.rcm.2020.01.590
Submitted: 7 November 2019 | Accepted: 29 December 2019 | Published: 30 March 2020
Copyright: © 2020 Macovei et al. Published by IMR press.
This is an open access article under the CC BY-NC 4.0 license
Left main disease