No More Debate Over Left Main Stenting Versus Bypass Surgery.

SEE PAGE 318 T raditionally, left main coronary artery disease had been regarded as a dominion of the cardiac surgeons on the basis of results from the classic trial comparing medical treatment and bypass surgery (1,2). However, several brave pioneers in interventional cardiology have continued to evaluate the performance of “less invasive” coronary stenting for the left main coronary artery stenosis due to its anatomical characteristics, including easy accessibility, large caliber, short lesion length, and lack of tortuosity (3–5). Furthermore, the widespread use of drug-eluting stents with advanced adjuvant technique and pharmacological treatment have lowered the threshold to perform left main stenting instead of bypass surgery for left main coronary artery disease (6–9). Subsequently, several clinical trials to compare left main stenting and bypass surgery were conducted. The LE MANS (Left Main Coronary Artery Stenting) trial was the first randomized comparison of left main stenting (n 1⁄4 52) and bypass surgery (n 1⁄4 53) (10). Drug-eluting stents were placed in 35% of the left main stenting group, and left internal mammary artery grafts were used in 72% of the bypass surgery group. The primary endpoint was an absolute change in left ventricular ejection fraction at 1 year, which was significantly higher in the percutaneous coronary intervention (PCI) group than in the coronary artery bypass grafting (CABG) group (3.3 6.7% vs. 0.5 0.8%; p 1⁄4 0.047). During 28 months of follow-up, there was a trend toward better long-term survival