TY - JOUR
T1 - PCI and CABG for Treating Stable Coronary Artery Disease
T2 - JACC Review Topic of the Week
AU - Doenst, Torsten
AU - Haverich, Axel
AU - Serruys, Patrick
AU - Bonow, Robert O.
AU - Kappetein, Pieter
AU - Falk, Volkmar
AU - Velazquez, Eric
AU - Diegeler, Anno
AU - Sigusch, Holger
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/3/5
Y1 - 2019/3/5
N2 - Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered revascularization procedures, but only CABG can prolong life in stable coronary artery disease. Thus, PCI and CABG mechanisms may differ. Viability and/or ischemia detection to guide revascularization have been unable to accurately predict treatment effects of CABG or PCI, questioning a revascularization mechanism for improving survival. By contrast, preventing myocardial infarction may save lives. However, the majority of infarcts are generated by non–flow-limiting stenoses, but PCI is solely focused on treating flow-limiting lesions. Thus, PCI cannot be expected to significantly limit new infarcts, but CABG may do so through providing flow distal to vessel occlusions. All comparisons of CABG to PCI or medical therapy that demonstrate survival effects with CABG also demonstrate infarct reduction. Thus, CABG may differ from PCI by providing “surgical collateralization,” prolonging life by preventing myocardial infarctions. The evidence is reviewed here.
AB - Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered revascularization procedures, but only CABG can prolong life in stable coronary artery disease. Thus, PCI and CABG mechanisms may differ. Viability and/or ischemia detection to guide revascularization have been unable to accurately predict treatment effects of CABG or PCI, questioning a revascularization mechanism for improving survival. By contrast, preventing myocardial infarction may save lives. However, the majority of infarcts are generated by non–flow-limiting stenoses, but PCI is solely focused on treating flow-limiting lesions. Thus, PCI cannot be expected to significantly limit new infarcts, but CABG may do so through providing flow distal to vessel occlusions. All comparisons of CABG to PCI or medical therapy that demonstrate survival effects with CABG also demonstrate infarct reduction. Thus, CABG may differ from PCI by providing “surgical collateralization,” prolonging life by preventing myocardial infarctions. The evidence is reviewed here.
KW - heart team
KW - prognosis
KW - survival benefit
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U2 - 10.1016/j.jacc.2018.11.053
DO - 10.1016/j.jacc.2018.11.053
M3 - Review article
C2 - 30819365
AN - SCOPUS:85061593577
SN - 0735-1097
VL - 73
SP - 964
EP - 976
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -
