Literature Review

Abstract

Current guidelines consider surgical treatment as the “gold standard” for unprotected left main coronary artery (ULMCA) revascularization, in the absence of functioning grafts. Indeed, surgery has been widely proven to be more effective in both the short and long term, compared to medical treatment. Starting from the 1960s, many clinical studies comparing surgical versus medical treatment have proved that isolated medical treatment of ULMCA disease is associated with a one-year mortality rate ranging between 24% and 53%. By contrast, surgical treatment significantly reduced mortality, with a 3-year survival rate of 88–93% [29, 30]. Among the surgical series to have provided the rationale for considering surgery the treatment of choice for ULMCA stenosis, the CASS (Coronary Artery Surgery Study) registry is the most extensive prospective study to have performed a comparison between the surgical and medical treatment of left main stenosis, with 1484 patients and a total follow-up of 16 years [31]. This study reported a mean survival of 13.3 years in 1153 patients treated surgically and 6.6 years in the 331 patients treated with medical therapy (P < 0.0001). Over the past decade the extensive experience reported in the literature on surgical treatment of the LMCA disease covers more than 11,000 patients, with a hospital mortality of 2.8% and a 1-month mortality ranging from 3% to 4.2% [32–37]. However, of these studies, only two [33, 34] had a follow-up of more than 1 year (2-year mortality: 5–6%) and none had a follow-up of over 2 years.