The estimated prevalence of left main artery disease found during diagnostic angiography is 6% in published series. The enthusiasm for a less invasive therapy than coronary artery bypass grafting (CABG) for patients with unprotected left main coronary artery (ULMCA) disease dates back to the 90s. Although the contribution of CABG in the survival of patients with ULMCA disease is undeniable, in the last few years, several authors have demonstrated the safety and efficacy of percutaneous coronary intervention (PCI).

Despite the controversies regarding the 5-year publication of the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial, when it comes to hard outcomes, as death and stroke, in the last years several randomized and non-randomized trials have demonstrated non-inferiority or even superiority of PCI against CABG. ^– Recently, these data were compiled in two meta-analysis where long term follow-up has shown no significant difference in mortality and stroke rate between PCI and CABG. ^, In addition, two of these randomized trials with extended long-term follow-up, up to 10 years, have demonstrated sustained good results after PCI, with death rates similar to CABG, respectively, 14.5% x 13.8% and 27% x 28%. ^,

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