Percutaneous coronary intervention versus coronary artery bypass surgery in multivessel disease: a current perspective.
Coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) are both safe and established treatment modalities of invasive revascularization for patients with coronary artery disease (CAD). However, conflicting information exists when comparing the long-term efficacy of the two methods. The optimal treatment for patients with multivessel coronary artery disease (MVD) is still subject to discussion, given the lack of fairly designed, prospective, randomized data reflecting current practice in the modern era. Furthermore, the clinical outcomes after invasive revascularization differ according to the number of diseased vessels, presence or absence of diabetes, left main disease and left ventricular dysfunction. Hence, the question arises whether we should continue to use the term 'multivessel disease'. Conflicts of available data need to be addressed and overcome so that care of patients with CAD can be successfully tailored. In this review article we try to address some of the above conflicts, in an effort to improve our understanding in the care of patients with multivessel disease. We also provide an evidence-based perspective which may differ from the current standard of practice.
Soran
Ozlem
O
Cardiovascular Institute, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, USA. soranzo@upmc.edu
Manchanda
Aarush
A
Schueler
Stephan
S
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics; D003324:Coronary Artery Disease / Q000191:economics / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome