The 2005 PCI guidelines466 recommended routine angio- graphic follow-up 2 to 6 months after stenting for uprotected 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.467 Experts have recommended immediate PCI for unprotected left main CAD in the setting of STEMI.339 The impetus for such a strategy is greatest when the left main CAD is the site of the culprit lesion, antegrade coronary flow is diminished [eg, Thrombolysis In Myocardial Infarction 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 cardiologist and cardiac surgeon should decide together on the optimal form of revascularization for these subjects, although it is recog- nized that these patients are usually critically ill and therefore not amenable to a prolonged deliberation or discussion of treatment options. 3.8. Proximal LAD Artery Disease A cohort study341 and a meta-analysis318 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 RCTs318,420,432,433,435,448,468 470 as well as collaborative- and meta-analyses451,471 473 showed that PCI and CABG result in similar survival rates in these patients. See Online Data Supplement 20 for additional data regarding proximal LAD artery revascularization. 3.9. Clinical Factors That May Influence the Choice of Revascularization 3.9.1. 