Key result
PCI achieves comparable outcomes to CABG in select patients with left main coronary disease.
Why the study?
The management of left main coronary artery disease has evolved with advancements in PCI and stent technology challenging the historical gold standard of CABG.
Effect estimate: OR 1.37 (95% CI 1.18-1.58)
Absolute Event Rate: 23.3% vs 18.2%
p-value: p=<0.0001
PCI may offer comparable outcomes to CABG in select LMCA patients; leaves open need for randomized confirmation before wider adoption.
The management of left main coronary artery (LMCA) disease has evolved over the past two decades. Historically, coronary artery bypass grafting (CABG) surgery has been the gold standard for the treatment of LMCA disease. However, with the advancements in percutaneous coronary interventions (PCIs) and stent technology, PCI in select patients has achieved comparable outcomes to CABG. As such, this has led to changes in the American College of Cardiology and European Society of Cardiology guidelines, which recommend that PCI might be an alternative to CABG in select patients. In this review article, we describe the historical perspective and early experience with coronary interventions of LMCA disease, landmark clinical trials and their effect on guidelines, and the role of intravascular imaging in the management of LMCA lesions.
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Alasnag et al. (2019) conducted a review in Left main coronary artery (LMCA) disease (n=4,404). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) at 3 to 5 years (OR 1.37, 95% CI 1.18-1.58, p=<0.0001).
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