PRECOMBAT: For Left Main Disease, PCI Not Inferior to CABG

Clearly, there are patients with left main coronary artery disease who can be treated percutaneously, but we don’t exactly know which subgroup. Duration of follow-up is important. With the 3-year data from SYNTAX we are seeing that in those with very complex disease there is benefit from surgery. PCI should not be done in these patients; but for the patients in the lowest tertile, PCI does very well. For the group in between, treatment should be individualized.

We are at a point where we can discuss the option of PCI for patients with unprotected left main disease. The extent of the patient’s non–left main disease is what would sway me. With diffuse disease I would swing toward surgery.

Dr. Bernard Gersh, professor of medicine at Mayo Clinic, Rochester, Minn., made his comments during a press briefing at the annual meeting of the American College of Cardiology. Dr. Gersh reported no relevant conflicts of interest.