Revascularization strategies for patients with stable coronary artery disease
Article first published online: 28 APR 2014
© 2014 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 276, Issue 4, pages 336–351, October 2014
How to Cite
Revascularization strategies for patients with stable coronary artery disease (Review). J Intern Med 2014; 276: 336–351., (South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK; Thorax Centre, Erasmus MC, Rotterdam, the Netherlands; and International Centre for Circulatory Health, Imperial College London, London, UK).
- Issue published online: 20 SEP 2014
- Article first published online: 28 APR 2014
- Accepted manuscript online: 1 APR 2014 07:03AM EST
- coronary artery bypass grafting;
- coronary artery disease;
- percutaneous coronary intervention;
Patients with coronary artery disease who have prognostically significant lesions or symptoms despite optimum medical therapy require mechanical revascularization with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) or both. In this review, we will evaluate the evidence-based use of the two revascularization approaches in treating patients with coronary artery disease. CABG has been the predominant mode of revascularization for more than half a century and is the preferred strategy for patients with multivessel disease, especially those with diabetes mellitus, left ventricular systolic dysfunction or complex lesions. There have been significant technical and technological advances in PCI over recent years, and this is now the preferred revascularization modality in patients with single-vessel or low-risk multivessel disease. Percutaneous coronary intervention can also be considered to treat complex multivessel disease in patients with increased risk of adverse surgical outcomes including frail patients and those with chronic obstructive pulmonary disease. Improvements in both CABG (including total arterial revascularization, off-pump CABG and ‘no-touch’ graft harvesting) and PCI (including newer-generation stents, adjunctive pharmacotherapy and intracoronary imaging) mean that they will continue to challenge each other in the future. A ‘heart team’ approach is strongly recommended to select an evidence-based, yet individualized, revascularization strategy for all patients with complex coronary artery disease. Finally, optimal medical therapy is important for all patients with coronary artery disease, regardless of the mode of revascularization.