Revascularization options for managing patients with multi-vessel coronary artery disease

Coronary revascularization can be achieved via coronary artery bypass (CABG) or percutaneous coronary intervention (PCI). CABG is associated with higher peri-procedural complications and longer recovery periods but greater long-term reduction in recurrent cardiac events compared to PCI. The preferred revascularization modality depends on various clinical and anatomic factors. In general, CABG is preferable for patients with complex coronary artery disease, especially in cases of concomitant diabetes or reduced left ventricular ejection fraction. Meanwhile, PCI is preferred in patients with less extensive disease or those at high surgical risk. However, patient preference should be a key part of the treatment decision. The majority of randomized evidence is based on primarily White, non-elderly male populations from high-income countries. More robust evidence is urgently needed for patients that are female, older, non-White, and from low- or middle-income countries. In this review, we summarize the current evidence for CABG and PCI, discuss the optimal revascularization strategies for different patient populations, and highlight future directions and knowledge gaps in the field of coronary revascularization.