Current evaluation and Management of Left Main Coronary Artery Disease
Keywords:
left main coronary disease, myocardial revascularization, percutaneos coronary intervention, coronary artery bypass surgeryAbstract
Introduction: In the past decade, the management of left main coronary artery disease has significantly increased through percutaneous coronary intervention. This trend is supported by multiple meta-analyses and randomized clinical trials demonstrating that this technique represents an acceptable alternative to coronary artery bypass grafting.
Objective: To describe the current evaluation and management of left main coronary artery disease.
Results: A lesion in the left main coronary artery is considered angiographically significant when it involves a stenosis of ≥ 50%. In cases of intermediate or ambiguous stenosis (30-69%), the indication for revascularization should not rely solely on visual angiographic assessment but must be based on a comprehensive evaluation including intravascular imaging, physiological assessment, and the identification of noninvasive clinical high-risk markers. A stenosis ≥ 70% constitutes a reasonable threshold for revascularization without requiring additional clinical criteria. Current evidence supports both percutaneous coronary intervention and coronary artery bypass grafting as safe and effective revascularization strategies, with comparable outcomes in terms of survival. However, percutaneous intervention is associated with a higher incidence of ischemic events and an increased need for repeat revascularization during follow-up.
Conclusions: Since both percutaneous coronary intervention and coronary artery bypass grafting play a fundamental role in the treatment of left main coronary artery disease, the choice of the optimal revascularization strategy in each patient should be made by a multidisciplinary team with expertise in the comprehensive management of this condition.
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