Percutaneous coronary intervention for left main coronary artery stenosis

Significant left main coronary artery disease (LMCAD) occurs in 5–7% of patients undergoing coronary angiography. Patients with LMCAD have a 50% 3-year mortality despite optimal medical therapy. As such, coronary artery bypass grafting (CABG) emerged as the gold standard therapy for the treatment of patients with LMCAD either in isolation or in association with disease elsewhere in the coronary circulation. Advances in stent and adjunctive intracoronary imaging as well as pharmacotherapy has enabled percutaneous coronary intervention (PCI) to challenge CABG in such patients, with a host of randomized and observational studies comparing the safety and efficacy of PCI with CABG. This chapter covers historical data on CABG in LMCAD, compares various PCI techniques with CABG, and finally evaluates the differences in efficacy and safety.