PCI or CABG for unprotected left main coronary artery disease?—new evidence justifies a change in perspective R. Andrew Archbold
Unprotected left main coronary artery disease (ULMD) is associated with an adverse prognosis (1,2). It was demonstrated almost a quarter of a century ago that patients with ULMD derive long-term prognostic benefit from coronary artery bypass graft surgery (CABG) compared with conservative treatment (3). The advent of coronary artery stenting quickly saw percutaneous coronary intervention (PCI) overtake CABG as the most commonly performed myocardial revascularisation procedure in patients with coronary artery disease as a whole (4). Only recently, however, has PCI been considered a genuine alternative to CABG for patients who have ULMD. This change in perspective arose due to improvements in balloon and stent technologies which facilitated complex PCI, pioneering PCI operators who brought ULMD PCI into mainstream clinical practice, and increasing evidence that PCI achieves favourable clinical outcomes in patients with ULMD.