Heart team approach for patients with unprotected left main coronary artery disease.

atients with unprotected left main coronary artery disease (LMCA) have a worse prognosis than any other form of coronary artery disease (CAD). During the past decade, the efficacy and safety of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for LMCA have been major topics for both interventional cardiologists and cardiac surgeons. CABG has been considered as the standard treatment modality for these patients, but as stent design, procedural technique and adjunctive medical therapy have improved, PCI has emerged as an alternative treatment option. Accordingly, PCI with stenting for LMCA was upgraded to a class IIa recommendation for properly selected patients in the 2012 guidelines of the United States.1 However, selection of optimal treatment for these patients remains controversial because of different clinical decision pathways and complicated evaluation of coronary anatomy and morbidity at the time of intervention.