Percutaneous coronary intervention versus bypass grafting in left main coronary artery disease

Without revascularization, patients with left main coronary artery disease (LMCAD) have a poor prognosis (1). There is a clear survival benefit from revascularization over medical management (1). Percutaneous coronary intervention (PCI) has been traditionally deferred in preference for coronary artery bypass grafting (CABG), due to the anatomic complexity (2). However, with the evolution of drug-eluting stents (DES), there has been a reduction in restenosis rates and mortality, repeat revascularization and major adverse cardiac and cerebrovascular events (MACCE) compared with bare metal stents (3). There has been a renewed interest in expanding the indication for PCI in patients with LMCAD (3). Despite this heightened interest in the comparative outcomes of DES versus CABG for patients with LMCAD, the choice for the optimal revascularization technique remains controversial.