Percutaneous coronary intervention for unprotected left main coronary artery stenosis

Table 2 Features favoring PCI or CABG

	Indications in favor of PCI	Indications in favor of CABG
Absolute	Suitable coronary anatomy for stenting with preserved left ventricular function (≥ 40%)	Patient who refuses PCI
	Patient who refuses surgery	Contraindication to antiplatelet therapy including aspirin, heparin, and thienopyridine (ticlopidine or clopidogrel)
		History of serious allergic reaction to stainless steel, drugs on drug-eluting stents, and contrast agent
		History of known coagulopathy or bleeding diathesis
		Pregnant women
Relative	Lesion restricted to the LMCA ostium or shaft	Complex coronary anatomies at LMCA, unsuitable for stenting (e.g. severe calcification, severe tortuosity, etc.)
	Isolated LMCA lesion	Total occlusions at other major epicardial coronary arteries (≥ 2)
	Bail-out procedure (e.g. dissection at the LMCA complicated during angiography or PCI)	Multivessel stenosis except LMCA
	Acute myocardial infarction at the LMCA, in which emergent revascularization is necessary	Decreased left ventricular dysfunction (< 40%)
	Cardiogenic shock due to LMCA stenosis, in which emergent revascularization is necessary	Extensive peripheral vascular disease, in which placement of guiding catheter or intra-aortic balloon pump is not likely to be performed
	Age ≥ 80 yr	In-stent restenosis at the LMCA, in which repeat PCI is not likely to be performed
	Serious co-morbid disease (e.g. chronic lung disease, poor general performance, etc.)
	Limited life expectancy of less than 1 yr
	Prior CABG
	Coronary anatomy, unsuitable for CABG (e.g. poor distal run-off)

CABG: Coronary artery bypass graft surgery; LMCA: Left main coronary artery; PCI: Percutaneous coronary intervention.