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Treatment of unprotected left main coronary artery disease with drug-eluting stents: is it time for a randomized trial?


The treatment of unprotected left main coronary artery disease by percutaneous intervention represents a considerable challenge for interventional cardiologists. The American College of Cardiology/ American Heart Association guidelines currently recommend surgical revascularization for this disorder and percutaneous interventions have thus far been performed only in exceptional cases, albeit with positive results in some patients. Technical limitations, however, including stent restenosis, limit the application of this technique at present. The availability of drug-eluting stents, which are associated with a reduction in angiographic restenosis, might change this situation. Preliminary results show that the implantation of drug-eluting stents for unprotected left main coronary artery lesions is a feasible and safe approach. Randomized clinical trials comparing the use of drug-eluting stents with coronary artery bypass surgery for unprotected left main coronary artery disease are the next step, but can such trials be contemplated at this stage? In this review we present an overview of the findings to date and discuss the direction that research should now take.

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Figure 1: Angiographic 5-month follow-up performed in an asymptomatic patient with negative stress test showing focal restenosis in a sirolimus-eluting stent at the ostium of circumflex artery.


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We thank Dr Pierfrancesco Agostoni for his help in the preparation of Figure 1.

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Correspondence to Antonio Colombo.

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The authors declare no competing financial interests.



A scoring system, based on patient-related factors, for the prediction of mortality within 30 days of cardiac surgery


In accordance with the EuroSCORE classification, a scoring system for the prediction of early mortality in cardiac surgical patients based on objective risk factors


The practice of treating narrowing in a coronary artery with an intervention based on the severity of stenosis alone, without seeking evidence of ischemia

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Chieffo, A., Colombo, A. Treatment of unprotected left main coronary artery disease with drug-eluting stents: is it time for a randomized trial?. Nat Rev Cardiol 2, 396–400 (2005).

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