[Left main intervention: options and limitations in interventional cardiology]

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Context:

• Left main stenosis (LMS) necessitates revascularization for improved long-term survival.
• Coronary artery bypass graft (CABG) surgery has been the standard treatment for LMS.
• Percutaneous coronary intervention (PCI) is increasingly considered for selected LMS patients.

Purpose:

• To evaluate the role and outcomes of PCI versus CABG in patients with left main stenosis.
• To identify patient subgroups suitable for PCI in LMS based on anatomical complexity and surgical risk.
• To provide evidence supporting updated clinical recommendations for LMS treatment.

Summary:

• Recent studies and the SYNTAX Trial indicate PCI can yield good results in specific LMS patient subgroups.
• Suitable candidates include those with isolated ostial LMS, LMS with single-vessel disease, low SYNTAX scores (<33), or high surgical risk.
• CABG remains preferred for complex anatomy (SYNTAX score >33) or multi-vessel disease.

Impact:

• PCI offers a viable revascularization option for carefully selected LMS patients, potentially expanding treatment choices.
• Management decisions should involve a heart team approach in specialized centers with surgical backup.
• Ongoing trials will further define the comparative efficacy of PCI versus CABG using hard clinical endpoints.