Stop the Invasion-Advances in Myocardial Revascularization

Myocardial revascularization remains a cornerstone in the management of acute coronary syndromes (ACS) and chronic coronary disease. Advances in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have significantly improved patient outcomes. PCI innovations include the evolution from balloon angioplasty to contemporary drug-eluting stents, imaging- and physiology-guided interventions, and the adoption of transradial access; all contribute to safer, more durable revascularization. Meanwhile, CABG continues to demonstrate superior long-term survival and freedom from major adverse cardiac events in good operative candidates with complex or multivessel coronary disease. Modern surgical innovations, including off-pump techniques and minimally invasive CABG, have reduced procedural trauma, enhanced recovery, helped to avoid aortic manipulations and maintain excellent patency and long-term survival outcomes. The integration of robotic assistance further enabled multiarterial nonsternotomy CABG, and represents a paradigm shift toward less invasive, curative approaches. The concept of hybrid coronary revascularization-combining the durability of CABG with the precision of PCI alongside guideline-directed medical therapy and multidisciplinary heart teams, is also central to the future of advanced coronary care. In this comprehensive review we highlight major milestones in myocardial revascularization, the unique contributions of Canadian research, and the ongoing transitions toward patient-centred, minimally invasive, and collaborative treatment models.