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Review
. 2022 Nov 21;43(44):4635-4643.
doi: 10.1093/eurheartj/ehac542.

Left main coronary disease: evolving management concepts

Paul W Armstrong  1   2 , Eric R Bates  3 , Mario Gaudino  4
Affiliations
Review

Left main coronary disease: evolving management concepts

Paul W Armstrong et al. Eur Heart J. .

Abstract

Remarkable advances in the management of coronary artery disease have enhanced our approach to left main coronary artery (LMCA) disease. The traditional role of coronary artery bypass graft surgery has been challenged by the less invasive percutaneous coronary interventional approach. Additionally, major strides in optimal medical therapy now provide a rich menu of treatment choices in selected circumstances. Although a LMCA stenosis >70% is an acceptable threshold for revascularization, those patients with a LMCA narrowing between 40 and 69% present a more complex scenario. This review examines the relative merits of the different treatment options, addresses key diagnostic and therapeutic unknowns, and identifies future work likely to advance progress.

Keywords: Coronary artery bypass graft; Left main coronary artery; Optimal medical therapy; Percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest: Armstrong reports grants and personal fees from Merck, Bayer, and Boehringer Ingelheim; grants from Boehringer Ingelheim/Eli Lilly and CSL Limited; and personal fees from Novo Nordisk. Gaudino reports grants or contracts from National Institute of Health and Canadian Institutes for Health and Research. Bates has no conflicts to report.

MeSH terms