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(Circulation. 2008;118:2326-2329.)
© 2008 American Heart Association, Inc.

Editorial

Coronary Artery Bypass Grafting Versus Stenting for Unprotected Left Main Coronary Artery Disease

Where Lies the Body of Proof?

Richard J. Shemin, MD

From the Professor and Chief, Division of Cardiothoracic Surgery, David Geffen School of Medicine, Executive Vice Chairman, Department of Surgery, Robert and Kelly Day Chair of Cardiothoracic Surgery, Codirector, UCLA Cardiovascular Center, UCLA Ronald Reagan Medical Center, Los Angeles, Calif.

Correspondence to Richard J. Shemin, MD, David Geffen School of Medicine, Division of Cardiothoracic Surgery, UCLA Ronald Reagan Medical Center, 10833 Le Conte Ave, 62-182 CHS, Los Angeles, CA 90095. E-mail rshemin@mednet.ucla.edu

Key Words: Editorials • coronary artery bypass grafting • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The standard of care for left main coronary artery disease is coronary bypass surgery (CABG). The efficacy and survival advantage of CABG have resulted in CABG being established practice since the 1970s.^1–3 Further improvements in late survival have been achieved with arterial grafting, which is practiced routinely even in patients more than 80 years of age.^4–6

Article p 2374

Technical advances in percutaneous coronary interventions (PCIs) and stent technology have emboldened the interventional cardiology community to test the feasibility of and document the procedural results for stenting the left main coronary artery.^7–14 Surgical approaches have a distinct advantage in that they can ignore the complexity and location of the left main coronary lesion, because bypass grafts are placed distally to the left anterior descending and circumflex coronary arteries. In addition, complete revascularization is easily accomplished.

The feasibility and success of PCI require an evaluation of lesion complexity. The probability of procedural success requires a consideration of whether the obstructing plaque involves the ostium of the coronary artery, the body of the left main, or the length of the left main and whether disease involves the bifurcation with or without extension into the left anterior descending or circumflex coronary arteries. Ostial or body obstructions in a long left main vessel are more desirable to stent than bifurcation or trifurcation lesions.^15–18 An additional consideration is the possibility of sudden stent thrombosis early or late after the use of drug-eluting stents (DES) or bare-metal stents. Such events in the left main coronary artery . . . [Full Text of this Article]

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