Abstracts

Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between a percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and severe composite issues, a higher percentage of stroke with CABG, and a higher rate of repeat revascularization with PCI. In this Review, we describe the pathophysiology of unprotected left primary coronary artery disease, discuss diagnostic approaches in light of new noninvasive and invasive imaging techniques, and detail risk stratification models to aid the Heart Team in the decision- making process for determining the best revascularization strategy for these patients.