Related Experiment Video
Updated: Oct 27, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Percutaneous Coronary Revascularization: JACC Historical Breakthroughs in Perspective
Patrick W Serruys1, Masafumi Ono2, Scot Garg3
1Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
Insights
Percutaneous coronary intervention and coronary artery bypass graft surgery are viable treatments for advanced coronary artery disease. Evolving technology and precision medicine necessitate ongoing evaluation of optimal revascularization strategies for individual patients.
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.
Abstract:
Over the last 4 decades, percutaneous coronary intervention has evolved dramatically and is now an acceptable treatment option for patients with advanced coronary artery disease. However, trialists have struggled to establish the respective roles for percutaneous coronary intervention and coronary artery bypass graft surgery, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease. Several pivotal trials and meta-analyses comparing these 2 revascularization strategies have enabled the relative merits of each technique to be established with regard to the type of ischemic syndrome, the coronary anatomy, and the patient's overall comorbidity. Precision medicine with individualized prognosis is emerging as an important method of selecting treatment. However, the never-ending advancement of technology, in conjunction with the emergence of novel pharmacological agents, will in the future continue to force us to reconsider the evolving question: "Which treatment strategy is better and for which patient?"
