Percutaneous Coronary Revascularization: JACC Historical Breakthroughs in Perspective

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology

Background:

• Percutaneous coronary intervention (PCI) has significantly advanced over 40 years.
• PCI is an established treatment for advanced coronary artery disease (CAD).

Observation:

• Comparing PCI and coronary artery bypass graft (CABG) surgery remains challenging, particularly for multivessel disease and unprotected left main CAD.
• Pivotal trials and meta-analyses have clarified the relative merits of PCI versus CABG based on ischemic syndrome, coronary anatomy, and patient comorbidities.

Findings:

• The choice between PCI and CABG depends on specific patient and disease characteristics.
• Precision medicine and individualized prognoses are increasingly important for treatment selection.

Implications:

• Continuous technological advancements and new pharmacological agents require ongoing reassessment of optimal revascularization strategies.
• The question of which revascularization strategy is superior and for whom remains a dynamic area of research.