Foreword

Article Outline

• Copyright

About 40 years ago, the significance of left main coronary artery disease (LMCAD) was not appreciated. In the early 1970s coronary arteriography was associated in some centers with an unacceptable complication rate which led to the first appreciation of the unique problem of LMCAD. Fortunately, in other centers the complication rates were lower. Since that time, appropriate care and attention to the special features of LMCAD with regard to diagnosis and management of these patients was developed and has been followed to the present time. Early data from the VA randomized trial in patients with LMCAD documented a better survival with coronary artery bypass surgery (CABG) than with “medical therapy” of that era and subsequent studies have confirmed those findings.

In this issue, Dr. Holmes and colleagues have provided a superb, comprehensive, authoritative, and up-to-date data on LMCAD. They have covered the anatomy, definition, and incidence and etiology of LMCAD. They have provided an exhaustive discussion of the diagnosis and treatment of LMCAD. An area of intense current clinical interest is the proper role of percutaneous coronary intervention in patients with LMCAD. Dr. Holmes has discussed this area in great detail and has provided recommendations and practical tips for stenting of LMCAD. There are 321 references.

The Editorial Board and I are grateful to Dr. Holmes and his colleagues for this review of a very important topic. Dr. David P. Faxon,^⁎ an expert interventional cardiologist, has provided important comments, and we also thank Dr. Faxon for a particularly rapid comment response.

• ⁎ David P. Faxon, MD, is Professor of Medicine, Harvard, Director of Strategic Planning, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, and Chief of Cardiology, West Roxbury VA Hospital, West Roxbury, MA.