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J Am Coll Cardiol, 2008; 51:893-898, doi:10.1016/j.jacc.2007.10.046
© 2008 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER AND COMMENTARY

The Left Main Facts: Faced, Spun, But Alas Too Few

Jeff Brinker, MD, FACC*

The Johns Hopkins Hospital, Baltimore, Maryland.

Manuscript received October 10, 2007; accepted October 24, 2007.

* Reprint requests and correspondence: Dr. Jeffrey A. Brinker, CMSC 501, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287. (Email: jbrinker{at}jhmi.edu).

Bypass surgery has been shown to prolong life in patients with significant left main stenosis compared with medical therapy and is the current standard of care. Recent registry data suggest that stenting may offer intermediate-term results similar to surgery, although with a greater need for repeat revascularization. Drug-eluting stents appear to improve the outcomes of stenting. Over 20% of patients with left main disease currently receive stents, and there is need for ongoing randomized controlled trials to validate this approach. It is essential that such patients receive balanced counseling as to revascularization options.

Abbreviations and Acronyms
  BMS = bare-metal stent(s)
  CABG = coronary artery bypass grafting
  DES = drug-eluting stent(s)
  ITA = internal thoracic artery
  LAD = left anterior descending coronary artery
  LM = left main coronary artery
  PCI = percutaneous coronary intervention
  ST = stent thrombosis




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