Different treatment options in chronic coronary artery disease: when is it the time for medical treatment, percutaneous coronary intervention or aortocoronary bypass surgery?
BACKGROUND
3% to 4% of the population suffers from chronic coronary artery disease (CAD). Primary care physicians, internists, cardiologists, and cardiac surgeons are involved in their long-term care. This article presents a complementary care pathway that integrates two apparently competing treatment options, aortocoronary bypass surgery (ACB) and percutaneous coronary intervention (PCI). Together with lifestyle changes and medical therapy, these treatments reduce morbidity and mortality and improve quality of life.


METHODS
This article was written by cardiac surgeons and cardiologists on the basis of the current treatment guidelines for coronary artery disease, a selective review of the literature (randomized, controlled trials and registry data), and a process of interdisciplinary consensus building.


CONCLUSIONS
Lifestyle changes can reduce cardiovascular risk factors, improve quality of life, and lower cardiovascular morbidity and mortality. They provide additional benefit over and above medical therapy and/or revascularization procedures and should be strongly recommended to all patients. Revascularization is not indicated for patients who are asymptomatic on medical therapy or who have only a small area of myocardial ischemia. With either PCI or ACB, the symptoms of angina pectoris can be markedly improved, or even eliminated. Both of these revascularization procedures should be accompanied by optimized medical treatment. Revascularization is indicated when the area of myocardial ischemia is large, whether or not symptomatic angina is present. ACB is the treatment of choice for 3-vessel disease and/or left main stenosis. For all other constellations of coronary findings, ACB and PCI are equally good therapeutic options. The treating physician should take the patient's expectations into account and present the short- and long-term benefits and drawbacks of each proposed treatment to the patient so that an informed decision can be made.
Russ
Martin
M
niversitätsklinik und Poliklinik für Innere Medizin III Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg Ernst-Grube-Str. 40 06120 Halle (Saale), Germany. martin.russ@medizin.uni-halle.de
Werdan
Karl
K
Cremer
Jochen
J
Krian
Arno
A
Meinertz
Thomas
T
Zerkowski
Hans-Reinhard
HR
D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D001026:Coronary Artery Bypass / Q000592:standards*; D003324:Coronary Artery Disease / Q000601:surgery*; D003661:Decision Support Techniques; D005104:Expert Testimony; D005858:Germany; D006801:Humans; D010348:Patient Care Team / Q000592:standards*; D017410:Practice Guidelines as Topic