Indications to revascularization in left main disease

Background and aim: Current guidelines recommend revascularization, either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), for patients with significant left main disease, especially when there is evidence of ischemia, left ventricular dysfunction, or high-risk anatomy Methods: An extensive review of the literature was performed, including the most recent guidelines and relevant manuscript on left main revascularization treatment. Results: CABG continues to be regarded as the gold standard, especially for individuals with complex coronary anatomy or impaired ventricular function. Conversely, PCI is considered a viable alternative in carefully selected patients who present with low-to-intermediate SYNTAX scores, favorable anatomical characteristics, and elevated surgical risk. Conclusions: Emerging evidence indicates that both CABG and PCI yield comparable early and long-term mortality outcomes. However, PCI is associated with increased rates of repeat revascularization and myocardial infarction over time, whereas CABG carries a higher early risk of stroke. (www.actabiomedica.it).