Treatment of left main and multivessel disease in the drug-eluting stent era.

For decades, the established standard of care for left main and multivessel coronary artery disease has been coronary artery bypass surgery because a significant survival advantage was found in patients revascularized with surgery compared with medical management. Although visions of less invasive strategies to manage this disease arose with the development of percutaneous coronary interventions, surgery proved to provide higher survival rates compared with balloon angioplasty and improved durability, with fewer required repeat revascularizations, compared with use of bare-metal stents. Drug-eluting stents revived hopes of an alternative treatment modality after trials demonstrated their safety and efficacy in other types of high-risk patients. Their wide-spread on- and off-label use led to several nonrandomized studies and, more recently, to randomized clinical trials comparing drug-eluting stents and bypass surgery.