title: Is There Still a Survival Advantage to Bypass Surgery Over Percutaneous Intervention in the Modern Era?
abstract: The method of revascularization for multi-vessel coronary artery disease (MVD) has traditionally been coronary artery bypass grafting (CABG), however, due to recent advances in the field of percutaneous coronary intervention (PCI), this latter technique has gained in popularity and its role in guidelines has been promoted. This review aims to address the current data available for the treatment of patients with complex coronary disease, including the specific disease subset in those with diabetes mellitus, focusing on the importance of risk stratification and review by the 'Heart Team'. The concept of complete versus incomplete revascularization and the assessment of lesions utilizing functional techniques are discussed. Over recent years, PCI has grown to become the most frequently performed therapeutic intervention in medicine and continues to grow. There are encouraging data that this is an effective and safe treatment option in selected patients, however, neither strategy alone can provide a solution for the entire spectrum of patients with MVD.
authors.affiliation: Department of Cardiology, North Cumbria University NHS Trust, Carlisle, United Kingdom.
authors.forename: Gill Louise
authors.initials: GL
authors.lastname: Buchanan
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy. Electronic address: colombo.antonio@hsr.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003661:Decision Support Techniques; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Drug-eluting stent; Heart team; Multi-vessel coronary artery disease; Percutaneous coronary intervention