[Bypass surgery or angioplasty: which treatment for which patient?]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Optimal medical therapy may not suffice for ischaemic heart disease when coronary arteries narrow.
• Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularisation options.
• Mortality and morbidity remain significant challenges in Non-ST-Elevation Myocardial Infarction (NSTEMI) despite treatment advances.

Purpose of the Study:

• To outline the decision-making process for PCI or CABG in ischaemic heart disease.
• To emphasize the role of the heart team and diagnostic work-up in guiding revascularisation.
• To highlight the importance of early risk stratification for NSTEMI patients.

Main Methods:

• Heart team consultation involving cardiothoracic surgeons and interventional cardiologists.
• Comprehensive diagnostic work-up, including coronary angiography.
• Patient presentation with written information supporting revascularisation.

Main Results:

• Heart team decisions integrate individual patient characteristics and coronary angiogram findings.
• Early risk stratification is crucial for determining appropriate treatment pathways (medical vs. interventional).
• Ad hoc PCI is specifically indicated for ST-Elevation Myocardial Infarction (STEMI) or haemodynamic instability.

Conclusions:

• Revascularisation decisions for ischaemic heart disease require a multidisciplinary heart team approach.
• Coronary angiography and patient-specific factors are paramount in guiding PCI or CABG selection.
• Effective risk stratification and timely intervention are key to improving outcomes in NSTEMI and STEMI.