Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Multivessel coronary artery disease (MVCAD) requires myocardial revascularization.
• Revascularization strategies include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
• Complete revascularization improves long-term prognosis but increases periprocedural risks compared to incomplete revascularization.

Purpose of the Study:

• To compare the outcomes of complete versus incomplete revascularization in MVCAD.
• To evaluate the role of CABG versus PCI in achieving optimal revascularization.
• To discuss guideline-based recommendations for revascularization modality selection in MVCAD.

Main Methods:

• Review of current international guidelines and clinical evidence.
• Analysis of factors influencing the choice between PCI and CABG.
• Consideration of coronary anatomy, ischemic burden, and patient comorbidities.

Main Results:

• CABG often achieves more extensive revascularization than PCI in MVCAD.
• PCI is generally preferred for single-vessel disease, low-risk MVCAD, or isolated left main disease.
• CABG is typically recommended for complex two-vessel disease, most three-vessel disease, and non-isolated left main disease.

Conclusions:

• The optimal revascularization strategy in MVCAD requires a multifactorial assessment.
• Adequacy of myocardial revascularization is a critical determinant of long-term outcomes.
• Individualized treatment decisions should balance procedural risk with the benefits of complete revascularization.