Left Main Coronary Artery Disease: Current Treatment Options

Significant left main coronary artery disease is defined as a greater than 50% angiographic narrowing of the vessel. In general, there are three options for the treatment of LMCA disease which include optimal medical therapy, percutaneous revascularization, or surgical revascularization, either off-pump or on-pump. It is the highest-risk lesion subset of ischemic heart disease and until recent years, coronary artery bypass grafting was the major choice of treatment. Although there is a marked increase in use of percutaneous coronary intervention in left main disease, there are still some questions about its efficacy when compared with surgery. Although bypass surgery is the gold standard, current treatment guideline recommendations canalized the treatment of this potentially lethal disease into percutaneous interventions in selected patients who had low to intermediate anatomic complexity. Left main disease with low SYNTAX scores (<= 22) can be treated either by bypass surgery or percutaneously, whereas SYNTAX score > 32 is an indication for only coronary artery bypass surgery. The heart team should always be in collaboration, give therapeutic options to patients and decide the best treatment strategy for the welfare of the patient.