Key result
Drug-eluting stents have dramatically reduced restenosis rates and provide comparable clinical outcomes to coronary artery bypass grafting for patients with unprotected left main coronary artery disease.
PCI with drug-eluting stents is a viable alternative to CABG for selected patients with unprotected left main coronary artery disease, particularly those with ostial or midbody lesions or high surgical risk.
May support PCI with drug-eluting stents as alternative to CABG in selected unprotected left main disease; leaves open need for dedicated randomized confirmation.
Coronary artery bypass grafting (CABG) is the gold standard for the treatment of left main disease, whereas percutaneous coronary intervention is a viable option for patients who are candidates for revascularization but ineligible for CABG. CABG is limited by extended hospital stay followed by rehabilitation and mediocre long-term patency of saphenous vein grafts. Drug-eluting stents decrease the restenosis rates compared with bare metal stents and provide comparable clinical outcomes with those of CABG. Patients with isolated left main disease limited to the ostium or midbody are most likely to have good clinical outcomes with low restenosis and stent thrombosis rates. The results of the ongoing EXCEL trial, which compares left main percutaneous coronary intervention with drug-eluting stents and CABG, will provide insight regarding the ideal revascularization strategy for these patients.
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Lee et al. (2011) conducted a review in Unprotected left main coronary artery (ULMCA) disease. Percutaneous coronary intervention with drug-eluting stents vs. Coronary artery bypass grafting (CABG) was evaluated. Drug-eluting stents have dramatically reduced restenosis rates and provide comparable clinical outcomes to coronary artery bypass grafting for patients with unprotected left main coronary artery disease.
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