Acute Thrombosis during Distal Left Main Stenting using Tap Technique in Patient Presenting with Non St-Elevation Acute Coronary Syndrome

Coronary artery bypass graft surgery continues to hold its preeminent position as treatment of choice for significant unprotected left main stem (UPLMS) artery disease. Recent randomized trials have however suggested that PCI may be considered reasonable alternative to CABG if the anatomy of LM disease is suitable and in acute coronary syndrome settings [1-6]. The SYNTAX trial randomly assigned 705 patients with distal LM disease to CABG or PCI and at 5 years follow up rates of death (CABG=14.6% vs. PCI =12.8%; P=0.53) and myocardial infarction (CABG=4.8% vs. PCI=8.2% P=0.10) were not significantly different. There were more strokes with CABG than PCI (15% vs. 4.3%; P=0.03) but repeat revascularization were lesser in the surgery patients (15.5% vs. 26.7%; P< 0.001) and no significant difference in overall major cardiovascular and cerebral events (MACCE). Importantly MACCE rates were comparable in the lower (0-22) and intermediate (22-32) SYNTAX score tertiles.