Current treatment of left main coronary artery disease

The patients with severe left main stem (LMS) stenosis have a very high risk of major cardiovascular events because of the extent of ischaemic myocardium. At 3rd year, the mortality rate for patients with significant LMS stenosis treated medically is 50%. Coronary artery bypass grafting (CABG) is considered the gold standard for the treatment of complex LMS stenosis, especially if it is associated with multivessel coronary disease. Many studies have showed that percutaneous coronary interventions (PCI) can be a safe and efficient alternative to CABG in carefully selected patients by the Heart Team, with similar mortality rates. The LMS PCI results have been continuously improved by the new PCI techniques developed and by the use of newer generation drug eluting stents. Furthermore, different invasive imagistic methods (intravascular ultrasound or optical coherence tomography) or haemodynamic assessment tools (fractional flow reserve) can improve the LMS PCI results. With those new developments in the technique of LMS PCI, the current guidelines about the treatment of left main coronary artery disease can be modified in the future.