What is the evidence for PCI to improve survival in patients with acute STEMI when an unprotected left main coronary artery is the culprit lesion?
The evidence for PCI to improve survival in patients with acute STEMI when an unprotected left main coronary artery is the culprit lesion is Level of Evidence C, Class IIb. PCI to improve survival may be reasonable as an alternative to CABG in selected stable patients with significant (>50% diameter stenosis) unprotected left main CAD with: 1) anatomic conditions associated with a low to intermediate risk of PCI procedural complications and an intermediate to high likelihood of good long-term outcome (eg, low intermediate SYNTAX score of <33, bifurcation left main CAD); and 2) clinical characteristics that predict an increased risk of adverse surgical outcomes (eg, moderate severe chronic obstructive pulmonary disease, disability from previous stroke, or previous cardiac surgery; STS-predicted risk of operative mortality >2%).301,305,307,311,319 336,340 (Level of Evidence: B) Class III: HARM.