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[Stenting or coronary artery bypass surgery for triple vessel disease?]

G Sleilaty1, P Achouh, J-N Fabiani

  • 1Service de chirurgie cardiovasculaire, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France.

Annales De Cardiologie Et D'Angeiologie
|October 22, 2008
PubMed

Insights

For multivessel coronary artery disease, surgery offers better long-term outcomes than percutaneous coronary intervention, reducing angina and repeat procedures. Mortality and heart attack rates are similar between treatments.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Context:

  • Multivessel coronary artery disease (CAD) requires revascularization.
  • Treatment options include angioplasty, stenting (bare metal and drug-eluting), and coronary artery bypass grafting (CABG).

Purpose:

  • To objectively analyze and compare the efficacy of different myocardial revascularization techniques in multivessel CAD.
  • To evaluate short- and long-term outcomes, including angina recurrence, repeat revascularization, mortality, and myocardial infarction.

Summary:

  • Randomized trials and registries indicate surgical revascularization has advantages over percutaneous coronary intervention (PCI) in reducing angina recurrence and the need for repeat procedures.
  • Mortality and myocardial infarction rates are comparable between surgical and percutaneous approaches.
  • Drug-eluting stents show limited short-term data and have not eliminated repeat revascularization needs, as disease progression occurs at new sites.

Impact:

  • Identifies high-risk subgroups (diabetes, renal failure, female gender) for multivessel CAD.
  • Highlights the importance of informing patients about the higher risk of repeat revascularization with PCI.
  • Suggests surgery may be favored for long-term management in multivessel CAD based on current evidence.

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