A Practical Approach to Left Main Coronary Artery Disease: JACC State-of-the-Art Review

Laura J. Davidson, Joseph C. Cleveland, Frederick G. Welt, Saif Anwaruddin, Robert O. Bonow, Michael S. Firstenberg, Mario F. Gaudino, Bernard J. Gersh, Kendra J. Grubb, Ajay J. Kirtane, Jacqueline E. Tamis-Holland, Alexander G. Truesdell, Stephan Windecker, Roza A. Taha, S. Chris Malaisrie*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Recent clinical practice guidelines provide clinicians with guidance; however, decisions regarding treatment for individual patients can still be difficult. The American College of Cardiology's Cardiac Surgery Team and Interventional Council joined together to develop a practical approach to the treatment of LM CAD, taking into account randomized clinical trial, meta-analyses, and clinical practice guidelines. The various presentations of LM CAD based on anatomy and physiology are presented. Recognizing the complexity of LM CAD, which rarely presents isolated and is often in combination with multivessel disease, a treatment algorithm with medical therapy alone or in conjunction with percutaneous coronary intervention or coronary artery bypass grafting is proposed. A heart team approach is recommended that accounts for clinical, procedural, operator, and institutional factors, and features shared decision-making that meets the needs and preferences of each patient and their specific clinical situation.

Original languageEnglish (US)
Pages (from-to)2119-2134
Number of pages16
JournalJournal of the American College of Cardiology
Issue number22
StatePublished - Nov 29 2022


  • coronary artery bypass grafting
  • coronary artery disease
  • left main coronary artery disease
  • myocardial revascularization
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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