Abstract
The choice between coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) for myocardial revascularization in patients with left main disease
(LMD) is controversial. There is general agreement that CABG is appropriate for all
patients, and PCI is acceptable for those with low-to-intermediate anatomic complexity.
However, there is uncertainty about the relative safety and efficacy of PCI in patients
with more complex LMD and with comorbidities such as diabetes. No direct comparison
trial has focused on revascularization in diabetic patients with LMD, and thus conclusions
on the topic are subject to the limitations of subgroup analysis, as well as the heterogeneous
exclusion criteria, and methodologies of individual trials. The available evidence
suggests that among diabetics, CABG is superior in patients with LMD with SYNTAX (SYNergy
between percutaneous coronary intervention with TAXus and dardiac surgery) score greater
than 33, distal bifurcation disease, or multivessel disease. PCI may be appropriate
in those with less-extensive disease or those with limited life expectancy or high
surgical risk.
Keywords
left main coronary artery disease - cardiac surgery - cardiovascular risk factors
- PCI - coronary intervention - insulin resistance - coronary artery
