[Thirty years of coronary revascularization in stable angina pectoris. Results of randomized controlled trials]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Stable angina pectoris management involves evaluating revascularization strategies.
• Coronary artery bypass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) are primary invasive options.
• Understanding the comparative therapeutic gain and complication risks is crucial.

Purpose of the Study:

• To compare the therapeutic benefits and complication risks of CABG versus PTCA in patients with stable angina pectoris.
• To identify patient subgroups who benefit most from invasive revascularization.

Main Methods:

• Systematic review and survey of randomized controlled trials.
• Analysis of survival data, cardiac events (death, myocardial infarction), angina relief, and complication frequencies.
• Stratification of results based on coronary artery disease severity (number of diseased vessels, left ventricular function).

Main Results:

• Invasive revascularization (CABG/PTCA) improved survival only in patients with three-vessel disease and/or left main lesions with reduced left ventricular function (less than 10% of patients).
• Patients with one- and two-vessel disease had better survival with conservative treatment.
• Angina relief was achieved long-term, but recurrence was earlier after PTCA than CABG.
• PTCA had a higher need for repeat revascularization (tenfold increase) and serious complications (>=10%) compared to CABG (>=7%).

Conclusions:

• CABG provides a survival advantage only in a small subset of high-risk patients with severe coronary artery disease.
• For the majority of patients with stable angina, conservative management or PTCA may be associated with comparable or better outcomes regarding survival and complications.
• While PTCA is less invasive initially, the higher rate of repeat procedures and complications negates its early advantage over CABG in certain patient groups.