Follow-up of left main patients treated with PCI or CABG

Patients who undergo left main coronary artery (LMCA) revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) are at high risk of adverse events resulting from lesion failure. Each revascularization strategy carries a different pattern of short and long-term risk, largely defined by distinct patient and procedural related factors that should be considered when defining the ideal follow-up strategy. Dual antiplatelet therapy is the most important modifier of downstream risk in the follow-up period, and its duration should be individualized. Risk scores derived from patients with non-LMCA disease can help clinicians balance the risks of bleeding and thrombosis. The utility of invasive and non-invasive testing for the detection of subclinical ischemia in this population remains an important area of uncertainty. In this chapter, we discuss the current evidence underlying the different aspects of follow-up for patients who have undergone LMCA revascularization.