Author + information
- Received July 3, 2007
- Revision received August 9, 2007
- Accepted September 7, 2007
- Published online March 4, 2008.
- David P. Taggart, MD (Hons), PhD, FRCS⁎,⁎ (, )
- Sanjay Kaul, MD, FACC†,
- William E. Boden, MD, FACC‡,
- T. Bruce Ferguson Jr, MD, FACC§,
- Robert A. Guyton, MD, FACC¶,
- Michael J. Mack, MD#,
- Paul T. Sergeant, MD, PhD††,
- Richard J. Shemin, MD, FACC⁎⁎,
- Peter K. Smith, MD, FACC∥ and
- Salim Yusuf, DPhil, FRCPC, FRSC, FACC‡‡
- ↵⁎Reprint requests and correspondence:
Prof. David P. Taggart, Cardiovascular Surgery, University of Oxford, Department of Cardiac Surgery, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
For coronary artery disease with unprotected left main stem (LMS) stenosis, coronary artery bypass grafting (CABG) is traditionally regarded as the “standard of care” because of its well-documented and durable survival advantage. There is now an increasing trend to use drug-eluting stents for LMS stenosis rather than CABG despite very little high-quality data to inform clinical practice. We herein: 1) evaluate the current evidence in support of the use of percutaneous revascularization for unprotected LMS; 2) assess the underlying justification for randomized controlled trials of stenting versus surgery for unprotected LMS; and 3) examine the optimum approach to informed consent. We conclude that CABG should indeed remain the preferred revascularization treatment in good surgical candidates with unprotected LMS stenosis.
- Received July 3, 2007.
- Revision received August 9, 2007.
- Accepted September 7, 2007.
- American College of Cardiology Foundation
- Pathology of LMS and Implications for Revascularization With Stents or Surgery
- Rationale for CABG as the “Standard of Care” Treatment for LMS Stenosis
- Current Results for CABG in LMS Stenosis
- PCI With BMS for LMS
- PCI With DES for LMS Stenosis
- Current Comparisons of PCI and CABG for LMS Stenosis
- Stent Thrombosis With DES
- Cautions Regarding Trials of Stents or Surgery in LMS Stenosis
- The Need for a Standardized Multidisciplinary Team Approach