What revascularization option should be considered for stable patients with significant unprotected left main coronary artery disease who have unfavorable anatomic or physiological criteria for revascularization?
It is reasonable to choose coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in patients with complex 3-vessel CAD (eg, SYNTAX score of 22) who are good candidates for CABG, 2-vessel disease with proximal left anterior descending artery (LAD) artery disease, and 2-vessel disease without proximal LAD artery disease. For patients with left ventricular dysfunction, CABG is recommended for those with an ejection fraction of 35% without significant left main CAD. For single vessel proximal LAD artery disease, CABG may provide long-term benefit, whereas the benefit of PCI for this condition is uncertain.