Revascularization of severe lef main and multivessel coronary artery disease has been shown to improve survival in both stable ischemic heart disease and acute coronary syndrome. While revascularization with coronary artery bypass surgery for these disease entities carries class I recommendation in most current guidelines, recent trials has shown potential comparable survival and cardiovascular outcomes between percutaneous and surgical interventions in patients with less complex coronary anatomy. Despite the conflicting results observed in the most recent lef main revascularization trials, Everolimus-Eluting Stents or Bypass Surgery for Lef Main Coronary Artery Disease (EXCEL) and Nordic-Baltic-British lef main revascularization (NOBLE), both treatment strategies remain important for the management of lef main disease (LMD) and multivessel disease (MVD) reflecting on the importance of heart team discussion. This review is focused on revascularization of LMD and MVD in patients who are not presenting with ST-segment elevation myocardial infarction, encompassing the evidence from historic and contemporary trials which shaped up current practices. This review discusses the heart team approach to guide decision making, including special populations that are not represented in clinical trials.
- Coronary artery bypass
- Coronary artery disease
- Coronary disease
- Percutaneous coronary intervention
ASJC Scopus subject areas
- Internal Medicine
- Cardiology and Cardiovascular Medicine