Key result
PCI with DES serves as an acceptable alternative to CABG for unprotected left main stenosis in high-risk patients.
Why the study?
Current guidelines do not recommend PCI for unprotected LMCA stenosis due to proven benefit of CABG and high restenosis rates with bare metal stents, but long-term outcomes with DES are reported acceptable and PCI is often used in high-risk or surgery-refusing patients.
Does percutaneous coronary intervention with drug-eluting stents provide an acceptable alternative to coronary artery bypass graft surgery in patients with unprotected left main coronary artery stenosis?
Does percutaneous coronary intervention with drug-eluting stents provide an acceptable alternative to coronary artery bypass graft surgery in patients with unprotected left main coronary artery stenosis?
This review highlights the potential of PCI with drug-eluting stents as an alternative to CABG for unprotected LMCA stenosis, particularly in high-risk patients, while calling for future randomized trials to establish definitive evidence.
May support PCI-DES consideration in high-risk unprotected LM stenosis; leaves open definitive role pending randomized trials.
Hemodynamically significant left main coronary artery (LMCA) stenosis is found in approximately 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left circumflex artery have no patent previous grafts. Previous randomized studies have demonstrated a significant reduction in mortality when revascularization by coronary artery bypass graft (CABG) surgery was undertaken compared with medical treatment. Therefore, current practice guidelines do not recommend percutaneous coronary intervention (PCI) for such a lesion, owing to the proven benefit of surgery and high rates of restenosis with the use of bare metal stents. However, with the advent of drug-eluting stents (DES), the long-term outcomes of PCI with DES to treat unprotected LMCA stenoses have been reported to be acceptable. Therefore, apart from the current guidelines, PCI for unprotected LMCA stenosis in many countries is often undertaken in individuals who are at very high risk of CABG or refuse to undergo a sternotomy. Future randomized studies comparing CABG versus PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in the clinical knowledge of adopting appropriate treatments.
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Park et al. (2008) conducted a review in Unprotected left main coronary artery (LMCA) stenosis. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) vs. Coronary artery bypass graft (CABG) surgery was evaluated. Percutaneous coronary intervention with drug-eluting stents is considered an acceptable alternative to bypass surgery for unprotected left main coronary artery stenosis in high-risk patients.
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