Percutaneous coronary intervention (PCI) using drug-eluting stents (DES) is 
currently considered as a viable alternative to coronary artery bypass graft 
surgery (CABG) for selected patients with left main coronary artery disease. The 
updated results of the landmark randomized trials comparing CABG versus PCI 
demonstrated comparable 5-year outcomes and are in line with the current 
guidelines that designate PCI as a reasonable treatment in this disease subset. 
Given that the completed randomized trials did not include contemporary DESs, 
the upcoming results of the ongoing trials evaluating the performance of 
new-generation DES compared with CABG (such as the EXCEL trial), may further 
help to clarify the current role and future recommendations of PCI for left main 
coronary artery disease. Apart from the recent stent technology, further 
improvements in outcomes after PCI may be possible when it is used with an 
integrated approach that combines functional concepts for decision-making, 
adjunctive imaging support and optimal pharmacotherapies.