title: Understanding the Outcome of Randomized Trials with Drug-Eluting Stents and Coronary Artery Bypass Graft in Patients with Multivessel Disease: A Review of a 25-Year Journey.
abstract: Randomized clinical trials (RCTs) with first- and second-generation drug-eluting stents (DESs) confirmed the superiority of coronary artery bypass surgery (CABG) in patients with multiple vessel disease. In spite of different DES designs, investigators in these trials used similar percutaneous coronary intervention (PCI) strategies hoping to achieve complete revascularization, meaning that all intermediate lesions would be stented. One of these studies also included small vessels in the revascularization policy. On this revision, authors searched for a potential explanation of these intriguing findings and also for solutions to this problem, not seen years ago when other RCTs compared CABG with PCI in the previous DES era. After they revised old and new scientific data, they concluded that improved DES design is not itself enough to narrow the gap between PCI and CABG and that in the future RCTs we should institute moreconservativestrategies avoiding unnecessary multiple DES implantation.
authors.affiliation: Head, Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina.; Director and Founder, Cardiovascular Research Center (CECI), Buenos Aires, Argentina.
authors.forename: Alfredo E
authors.initials: AE
authors.lastname: Rodriguez
authors.affiliation: Fellow, Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina.
authors.forename: Hernán
authors.initials: H
authors.lastname: Pavlovsky
authors.affiliation: Fellow, Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Del Pozo
keywords: completeness of revascularization; coronary artery bypass surgery; drug-eluting stents; multiple vessel disease; randomized clinical trials