[Clinical decision making in left main coronary artery disease revascularization: the past, present and future]
Fabio Dipasqua1, Davide Capodanno, Corrado Tamburino
1Divisione di Cardiologia, Ospedale Ferrarotto, Università di Catania.
Insights
Revascularization for left main coronary artery disease offers percutaneous coronary intervention as a viable alternative to traditional bypass surgery. Treatment decisions require expert Heart Team evaluation and risk stratification for optimal patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Context:
- Left main coronary artery disease (LMCA) revascularization is a complex clinical challenge.
- Coronary artery bypass grafting (CABG) is the established gold standard.
- Percutaneous coronary intervention (PCI) is emerging as a comparable alternative.
Purpose:
- To provide an updated overview of LMCA revascularization treatment options.
- To highlight current indications based on international guidelines.
- To review risk stratification systems and future clinical developments.
Summary:
- This review examines the evolving landscape of LMCA revascularization, comparing PCI and CABG outcomes.
- It emphasizes the critical role of Heart Team discussion and risk stratification in treatment selection.
- Current guidelines and emerging clinical advancements are discussed.
Impact:
- Informs clinical decision-making for LMCA disease management.
- Facilitates personalized treatment strategies by integrating risk assessment.
- Contributes to the ongoing debate on optimal revascularization techniques.
Abstract:
Left main coronary artery disease revascularization is one of the most debated topics in the setting of interventional cardiology. Although the gold standard therapy for left main disease is coronary artery bypass grafting, growing evidences suggest similar outcomes for percutaneous coronary intervention compared to cardiac surgery. The decision-making process aimed at selecting the best treatment option is a complex task requiring advanced expertise, Heart Team discussion, and risk stratification. The aim of this review is to provide an updated overview of treatment options for left main revascularization, highlighting current indications based on the latest international guidelines, reviewing the most important risk stratification systems with a glimpse to further clinical development in the field.
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