Revascularization options for managing patients with multi-vessel coronary artery disease
Arnar B Ingason1, Alexander C Gregg1, Bjorn Redfors1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States of America.
Insights
Coronary revascularization via coronary artery bypass (CABG) or percutaneous coronary intervention (PCI) depends on patient factors. CABG offers long-term benefits for complex disease, while PCI suits less severe cases or high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary revascularization is crucial for managing coronary artery disease.
- Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary revascularization methods.
- Choosing between CABG and PCI involves balancing procedural risks, recovery, and long-term outcomes.
Purpose of the Study:
- To review current evidence comparing CABG and PCI.
- To discuss optimal revascularization strategies for diverse patient groups.
- To identify knowledge gaps and future research directions in coronary revascularization.
Main Methods:
- Systematic review of existing randomized controlled trials and observational studies.
- Analysis of clinical outcomes, including peri-procedural complications, recovery times, and recurrent cardiac events.
- Stratification of evidence based on patient demographics (sex, age, race) and socioeconomic factors.
Main Results:
- CABG is linked to higher initial complications and longer recovery but better long-term event reduction.
- PCI is favored for less complex disease and in patients with high surgical risk.
- Treatment choice should integrate clinical, anatomical factors, and patient preference.
Conclusions:
- The optimal choice between CABG and PCI is multifactorial.
- Current evidence predominantly reflects specific demographics, necessitating broader research.
- Future research should focus on underrepresented populations to guide equitable revascularization strategies.
Abstract:
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.
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