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Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.
Open Access
Review
Left Main Coronary Artery Disease: Is CABG Still the Gold Standard?
Martin K. C. Ng*, †, Alan C. Yeung*
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1
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
2020
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
Rev. Cardiovasc. Med. 2005, 6(4), 187–193;
Published: 30 December 2005
Abstract
Severe stenosis of the left main coronary artery (LMCA) is a coronary artery-disease
manifestation of critical prognostic importance. As a consequence of the survival advantage
conferred by coronary artery bypass grafting (CABG) over medical therapy,
lesions in the LMCA have been considered a standard indication for CABG for nearly
3 decades. Initial attempts to treat LMCA disease percutaneously by balloon angioplasty
resulted in poor clinical outcomes, leading many to regard significant LMCA
disease as a contraindication for percutaneous coronary intervention (PCI). However,
the development and refinement of coronary stenting over the last 15 years, followed
by the recent introduction of drug-eluting stents, has fueled renewed interest in
percutaneous treatment of LMCA disease. Outcomes of recent studies using sirolimusand/or
paclitaxel-eluting stents for treatment of LMCA disease have yielded rates of
in-hospital and 1-year mortality that compare favorably with those of surgery. This
article will review the natural history of LMCA disease, the outcomes of CABG for
LMCA disease, and the history and recent developments regarding PCI for LMCA
disease.
Keywords
Coronary artery disease
Left main
Stenting