Should all patients with asymptomatic but significant (>50%) left main coronary artery stenosis undergo surgical revascularization?

The incidental detection of asymptomatic but significant ( 50%) left main coronary artery disease (LMCAD) has become more frequent with the increased use of coronary angiography for acute myocardial infarction. Most would agree that such LMCAD cannot be ignored. Yet, clarity is somewhat lacking as to the best approach to managing such patients. The long-running debate of the best revascularization method of LMCAD has flared up again. However, medical management also may be a viable option for some of these patients.