Revascularization in advanced stable coronary artery disease

Identifying patients with stable coronary artery disease (CAD) who benefit from revascularization is a challenge for the clinician. Based on survival data, we have devised a guide to help the clinician decide which patients with advanced stable CAD should be treated more aggressively with revascularization and which patients may be followed with medical therapy alone. Survival data support the recommendation of coronary artery bypass grafting (CABG) when at least two of the following factors are present: advanced CAD, left ventricular (LV) dysfunction and significant ischemia. For patients with advanced CAD and LV dysfunction, or left main coronary artery disease, CABG remains the treatment of choice. In patients with normal LV function, but advanced CAD and significant ischemia, percutaneous transluminal coronary angioplasty (PTCA) and CABG appear to provide similar survival outcomes. While CABG is more invasive and is associated with a longer recovery period, PTCA is associated with more repeat revascularization procedures on follow-up than CABG. Thus, while the recommendation for revascularization in advanced stable CAD is made based on survival data, in some patients the choice of revascularization procedure may depend on the needs and preferences of the individual patient.