It is known and proven that the degree of damage to the left main coronary artery (LMCA), along with the indicators of  the left ventricle (LV) myocardium’s contractile function, are the main factors determining the survival of patients with coronary artery disease (CAD). Therefore, the effectiveness of the chosen management strategy for such patients determines not only the quality of life, i.e relief from angina symptoms, but also long-term prognosis [1,2].

survival of patients, Contractile function

Windecker S., Kolh Ph., Alfonso F., Collet J., Cremer J., Falk V. 2014 ESC/EACTS Guidelines on myocardial revascularization The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. DOI: 10.1093/eurheartj/ehu 278.

Pod redakcja Roberta J. Gilla Choroba pnia glownego lewej tetnicy wiencowej w przebiegu miazdzycy 2012; 1: 4-16.

Herric J. Clinical features of sudden obstruction of the coronary arteries. JAMA. 1912; 59: 2015–22.

DeMots H., Bonchek L.I., Rosch J., Anderson R.P., Starr A., Rahimtoola S.H. Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization. Am. J. Cardiol. 1975; 36:136–41.

Fajadet J., Chieffo A. Current management of left main coronary artery disease. Eur. Heart J. 2012; 33 (1): 36–50.

Baroldi G., Mantero O., Scomazzoni G. The collaterals of the coronary arteries in normal and pathologic hearts. Circ. Res. 1956; 4: 223–9.

Chikwe J., Kim M., Goldstone A.B., Fallahi A., Athanasiou T. Current diagnosis and management of left main coronary disease. Eur. J. Cardiothorac. Surg. 2010; 38: 420–30.

Dodge Jr. J.T., Brown B.G., Bolson E.L., Dodge H.T. Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. Circulation. 1992; 86: 232–46.

James T.N. Anatomy of coronary arteries. Circulation. 1965; 32: 1020–33.

Johnson A.D., Detwiler J.H., Higgins C.B. Left coronary artery anatomy in patients with bicuspid aortic valves. Br. Heart J. 1978; 40: 489–93.

Yamanaka O., Hobbs R.E. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet. Cardiovasc. Diagn. 1990; 21 (1):

–40.

Bergelson B.A., Tommaso C.L. Left main coronary artery disease: assessment, diagnosis, and therapy. Am. Heart J. 1995; 129: 350–9.

Ku D.N., Giddens D.P., Zarins C.K., Glagov, S. Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arterioscler. Thromb. Vasc. Biol. 1985; 5: 293–302.

Аkbasheva М.Т., Zakaryan N.V., Alekyan B.G.. Atherosclerosis and its complications. Current issues in the diagnosis and treatment of ischemic heart disease. Creative cardiology 2009; 2: 68–79.

Rabkin I. Kh., Tkachenko V.M., Abugov A.M.. Stenosis of the Left main coronary artery: clinical, coronagraphic, hemodynamic parallels and contractile function of the left ventricle. Azerbaijan Medical journal. 1984; 3: 39–44.

Kuznetsov V.A., Bessonov I.S., Ziryanov I.P., Samoylova E.P., Gorbatenko Е.А., Ignatov D.I. Clinical and functional characteristics and treatment of patients with LMCA disease in real-world clinical practice. Cardiology. 2014; 1: 55–60.

Caracciolo E.A., Davis K.B., Sopko G., Kaiser G.C., Corley S.D., Schaff H. et al. Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease long-term CASS experience. Circulation. 1995; 91: 2335–44.

Oviedo C., Maehara F., Mintz G.S., Araki H., Choi S.Y., Tsujita K. et al. Intravascular ultrasound classification of plaque distribution in left main coronary artery bifurcations where is the plaque really located. Circulation: Cardiovasc. Interv. 2010; 3 (2): 105–12.

Fassa A.A., Wagatsuma K., Higano S.T., Mathew V., Barsness G.W. et al. Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease: a long-term follow-up study. J. Am. Coll. Cardiol. 2005; 45 (2): 204–11.

Andersen K., Vik-Mo H., Omvik P. Can left main or proximal left anterior descending coronary artery disease be assessed by non-invasive means. Acta Med. Scand. 1982; 212 (6): 361–5.

Aoki J., Hoye A., Staferov A.V., Alekyan B.G., Serruys P.W. Sirolimus-eluting stent implantation for chronic total occlusion of the left main coronary artery. J. Interv. Cardiol. 2005; 18 (1): 65–9.

Dacosta A., Tardy B., Favre J.P., Guy J.M., Rachet F., Lamaud M. et al. Left main coronary artery disease. Arch. Mal. Coeur Vaiss. 1994; 87 (9): 1225–32.

Sianos G., More M., Kappetein A.P., Morice M., Colombo A., Dawkin K. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroInterv. 2005; 1: 219–27.

Favaloro R.G., Effler D.B., Groves L.K., Sheldon W.C., Shirey E.K., Sones F.M., Jr. Severe segmental obstruction of the left main coronary artery and its divisions. Surgical treatment by the saphenous vein graft technique. J. Thorac. Cardiovasc. Surg. 1970; 60: 469–82.

Cohen V., Gorlin R. Main left coronary artery disease. Clinical experience from 1964–1974. Circulation. 1975; 52: 275–85.

Gotsman M.S., Lewis B.S., Bakst A. Obstruction of the left main coronary artery – the artery of sudden death. S. Afr. Med. J. 1973; 47 (15): 641–4.

Mehta J., Hamby R.I., Hoffman I., Hartstein M.L., Wisoff B.G. Medical-surgical aspects of left main coronary artery disease. J. Thorac. Cardiovasc. Surg.

; 1 (1): 137–41.

Pryor D.B., Shaw L., Harrell F.E., Jr, Lee K.L., Hlatky M.A., Mark D.B. et al. Estimating the likelihood of severe coronary artery disease. Am. J. Med. 1991; 90: 553–62.

Kallikazaros I., Tsioufis C., Sideris S., Stefanadis C., Toutouzas P. Carotid artery disease as a marker for the presence of severe coronary artery disease in patients evaluated for chest pain. Stroke. 1999; 30: 1002–7.

Iqbal J., Serruys P.W. Revascularization strategies for patients with stable coronary artery disease. J. Intern. Med. 2014; 276 (4): 336–51.

Prapas S.N., Tsakiridis K., Zarogoulidis P., Katsikogiannis N., Tsiouda T., Sakkas A. et al. Current options for treatment of chronic coronary artery disease. J. Thorac. Dis. 2014; 6 (1): 2–6.

Rogers W., Chaitman В., Fisher L. et al. Comparison of the cumulative survival among patient groups with a left main coronary artery lesion after surgical and therapeutic treatment // J. Kardiologiia. — 1982. — Vol. 22 (2). — P. 53–57.

Taggart D., Kaul S., Boden W.E. et al. Revascularisation for unprotected left main stem coronaryartery stenosis: stenting or surgery // J. Am. Coll. Cardiol. 2008. — Vol. 51. — P. 885–892.

Dacosta A., Tardy В., Favre J. et al. Left Main Coronary Artery Disease // Arch. Mal. Coeur. Vaiss. — 1994. — Vol. 87 (9). — P. 1225–1232.

Caracciolo E., Davis K., Sopco G. et al. Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience // Circulation. — 1995. — Vol. 91. — P. 2325–2334.

Serruys P.W., Unger F., Sousa J.E. et al. Comparison of coronary artery bypass surgery and stenting for the treatment of multivessel disease. N. Engl. J. Med. 2001; 344: 1117–24.

Hannan E.L., Racz M.J., Walford G. et al. Longterm outcomes of coronary-artery bypass grafting versus stent implantation. N. Engl. J. Med. 2005; 352: 2174–83.

The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patientswith multivessel disease. N. Engl. J. Med. 1996; 335: 217–25.

Eyal A., Adler Z., Boulos M., Marai I. An unusual cause for ventricular fibrillation following cardiac surgery. IMAJ. 2013; 15: 254–5.

Serruys P.W., Morice M.C., Kappetein A.P. et al. SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N. Engl. J. Med. 2009; 360: 961–72.

Mohr F.W., Morice M.C., Kappetein A.P. et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013; 381: 629–38.

ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2014; 35, 2541–619.

Boden W.E., Mancini G.B. CABG for complex CAD: when will evidence-based practice align with evidence-based medicine? J. Am. Coll. Cardiol. 2016; 67: 56–8.

Hannan E.L., Racz M.J., Gold J., Cozzens K., Stamato N.J., Powell T. et al. Adherence of catheterization laboratory cardiologists to American College of Cardiology/American Heart Association guidelines for percutaneous coronary interventions and coronary artery bypass graft surgery: what happens in actual practice. Circulation. 2010; 121: 267–75.

Mack M., Baumgarten H., Lytle B. Why surgery won the SYNTAX trial and why it matters. J. Thorac. Cardiovasc. Surg. 2016; 152: 1237–40.

Bokeriya O.L., Bazarsadayeva Т.S., Shvarts V.А., Аkhobekov А.А. Effectiveness of statin therapy in preventing atrial fibrillations in patients after CABG. Annals of arrhythmology. 2014; 11 (3): 160–9. DOI: 10.15275/annaritmol.2014.3.

Nerlekar N., Ha F.J., Verma K.P., Bennett M.R.,Cameron J.M. et al. Percutaneous coronary intervention using drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary artery stenosis a meta-analysis of randomized trials. Circ. Cardiovasc. Interv. 2016; 9: e004729.

Ahn J.M., Roh J.H., Kim Y.H., Park D.W.,Yun S.C., Lee P.H. et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease: 5-year outcomes of the PRECOMBAT study. J. Am. Coll. Cardiol. 2015; 65: 2198–206.

Morice M.C., Serruys P.W., Kappetein A.P., Feldman T.E. et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation. 2014; 129: 2388–94.

Mäkikallio T., Holm N.R., Lindsay M., Spence M.S., Erglis A. et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 2016; 388 (10061): 2743.

Stone G.W., Sabik J.F., Serruys P.W., Simonton C.A., Généreux P., Puskas J., Kandzari D.E.

et al. EXCEL Trial Investigators. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N. Engl. J. Med. 2016; 375: 2223–5.

Boudriot E., Thiele H., Walther T., Liebetrau C.,Boeckstegers P., Pohl T., Reichart B. et al. Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J. Am. Coll. Cardiol. 2011; 57: 538–45.

Cho Y., Shimura S., Aki A., Furuya H., Okada K., Ueda T. The SYNTAX score is correlated with long-term outcomes of coronary artery bypass grafting for complex coronary artery lesions.

Interact. Cardiovasc. Thorac. Surg. 2016; 23 (1): 125–32. DOI: 10.1093/icvts/ivw057.

Sanchez-Perez I., Piqueras-Flores J., Jurado A.et al. High Syntax score and left main percutaneous coronary intervention in high risk patients. Results at a 10 year follow-up. J. Am. Coll. Cardiol. 2016; 68 (18) (Suppl. B): 120–1.