Revascularization treatment recommendations based on atherosclerotic disease distribution: coronary artery bypass grafting versus stenting.
In patients with coronary artery disease, the need for more accurately defined treatment recommendations based on the distribution of atherosclerotic disease has given rise to multiple trials designed to evaluate the efficacy of medical therapy versus percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). To clarify these treatment recommendations, we reviewed relevant trials. Patients with chronic stable angina who have one-vessel or two-vessel coronary artery disease without involvement of the left main or left anterior descending coronary arteries fare similarly regardless of treatment modality. In contrast, patients with multivessel disease and inducible ischemia are better served by revascularization by either CABG or PCI. In patients who have left main involvement, diffuse disease with severe atherosclerosis, diabetes mellitus, advanced age, or left ventricular dysfunction, the outcome with regard to survival, anginal relief, and freedom from additional intervention is better with CABG than with PCI.
de la Cruz
Kim I
KI
Texas Heart Institute, MC 3-258, PO Box 20345, Houston, TX 77225, USA.
Tsai
Peter I
PI
Cohn
William E
WE
Cooley
Denton A
DA
D000787:Angina Pectoris / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D023921:Coronary Stenosis / Q000601:surgery / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D003925:Diabetic Angiopathies / Q000401:mortality; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012086:Reoperation; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine