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STATE-OF-THE-ART PAPER AND COMMENTARY

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

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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