It can be argued that severe left main coronary artery (LMCA) disease
represents the only anatomic subtype of coronary artery disease for
which there is clear and unequivocal prognostic evidence in favor of
coronary revascularization across the spectrum of clinical
presentation—from stable ischemic heart disease to acute coronary
syndrome. For decades, the standard approach to LMCA revascularization
has been through coronary artery bypass grafting (CABG) given its
ability to safely and effectively achieve complete revascularization.
More recently, revascularization through percutaneous coronary
intervention (PCI) has been proposed as an alternative to CABG for
traditionally surgical anatomy. Predicate data from the Synergy Between
Percutaneous Coronary Intervention with Taxus and Cardiac Surgery
(SYNTAX) clinical trial and other clinical trials have suggested that
the LMCA may be ideally suited to maximize the potential relative
benefits of PCI (less invasiveness, ideally suited for larger vessels
with more focal disease) while mitigating its relative disadvantages
(restenosis and stent thrombosis, especially when tackling diffuse
disease). However, until recently, the prospective evidence base on
which this assertion was based was limited.
