title: [Angioplasty or surgery in the patient with multivessel disease].
abstract: The aims of myocardial revascularisation are to treat angina, reduce ischaemia and improve life expectancy. Patients with multivessel disease have a poor prognosis, especially when the lesions are proximal, when the preseptal left anterior descending artery is involved and when left ventricular dysfunction is present. In this particular group of patients, coronary bypass surgery has been shown to improve 10 year survival. Coronary angioplasty has been compared with surgical treatment in many clinical trials. The medium-term survival is the same in both groups, but with a higher number of repeat procedures except in diabetic patients in whom mortality is higher after angioplasty. The use of coronary stents should reduce the number of post-angioplasty procedures. Constant technical improvements, the introduction of surgery without cardiopulmonary bypass, combined revascularisation procedures, new antiplatelet drugs, the absence of long-term comparative results, all this results in a personalized choice of revascularisation procedure based on the overall clinical and angiography features of each particular case.
authors.affiliation: Service de cardiologie, hôpital Emile-Muller, Mulhouse.
authors.forename: J P
authors.initials: JP
authors.lastname: Monassier
authors.forename: L
authors.initials: L
authors.lastname: Jacquemin
authors.forename: P
authors.initials: P
authors.lastname: Ohlmann
authors.forename: R
authors.initials: R
authors.lastname: Zélinsky
authors.forename: C
authors.initials: C
authors.lastname: Cordier
authors.forename: R
authors.initials: R
authors.lastname: Dallemand
authors.forename: J
authors.initials: J
authors.lastname: Lévy
authors.forename: F
authors.initials: F
authors.lastname: Panès
authors.forename: N
authors.initials: N
authors.lastname: Bischoff
authors.forename: G
authors.initials: G
authors.lastname: Laval
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
vernacular_title: Angioplastie ou chirurgie chez le patient pluritronculaire.