The 2005 PCI guideline987 recommended routine angio- graphic follow-up 2 to 6 months after stenting for unprotected left main CAD. However, because angiography has limited ability to predict stent thrombosis and the results of SYNTAX suggest good intermediate-term results for PCI in subjects with left main CAD, this recommendation was removed in the 2009 STEMI/PCI focused update.3 Experts have recommended immediate PCI for unprotected left main CAD in the setting of STEMI.983 The impetus for such a strategy is greatest when left main CAD is the site of the culprit lesion, antegrade coronary flow is diminished (eg, TIMI flow grade 0, 1, or 2), the patient is hemodynamically unstable, and it is believed that PCI can be performed more quickly than CABG. When possible, the interventional car- diologist and cardiac surgeon should decide together on the optimal form of revascularization for these subjects, although it is recognized that these patients are usually critically ill and therefore not amenable to a prolonged deliberation or discus- sion of treatment options. 5.8. Proximal LAD Artery Disease A cohort study985 and a meta-analysis412 from the 1990s suggested that CABG confers a survival advantage over contemporaneous medical therapy for patients with disease in the proximal segment of the LAD artery. Cohort studies and RCTs412,1050,1062,1063,1065,1077,1093 1095 as well as collaborative analyses and meta-analyses1080,1096 1098 showed that PCI and CABG result in similar survival rates in these patients. See Online Data Supplements 6 and 14 for additional data on proximal LAD artery disease. 5.9. Clinical Factors That May Influence the Choice of Revascularization 5.9.1. 