Revascularization in stable coronary disease: evidence and uncertainties

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Demosthenes G Katritsis1, Daniel B Mark2, Bernard J Gersh3

  • 1Department of Cardiology, Hygeia Hospital, Athens, Greece. dkatrits@dgkatritsis.gr.

Nature Reviews. Cardiology
|April 15, 2018
PubMed

Insights

Revascularization for stable coronary artery disease (CAD) relies on outdated evidence. This review examines current decision-making factors and compares coronary artery bypass grafting (CABG) surgery with percutaneous coronary intervention (PCI).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Revascularization is a key treatment for obstructive coronary artery disease (CAD).
  • Evidence supporting revascularization for stable CAD is limited, predating modern optimal medical therapy and revascularization techniques.
  • Existing clinical trials, though outdated, still inform current guidelines for stable CAD.

Purpose of the Study:

  • To discuss factors influencing the decision for revascularization in stable CAD.
  • To examine the evidence and limitations for revascularization in stable CAD.
  • To compare coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI).

Main Methods:

  • Review of existing clinical trial evidence.
  • Analysis of contemporary standards for optimal medical therapy.
  • Evaluation of current revascularization techniques and technologies.

Main Results:

  • Evidence for stable CAD is less robust than for acute coronary syndromes.
  • Contemporary optimal medical therapy and revascularization techniques have evolved significantly.
  • Guideline indications for stable CAD are based on foundational, albeit dated, clinical trials.

Conclusions:

  • The decision for revascularization in stable CAD requires careful consideration of outdated evidence and modern therapeutic advancements.
  • A critical evaluation of existing data is necessary to guide the choice between CABG and PCI.
  • Further research may be needed to align evidence with current clinical practice for stable CAD management.

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