PCI and CABG for Treating Stable Coronary Artery Disease: JACC Review Topic of the Week

Torsten Doenst*, Axel Haverich, Patrick Serruys, Robert O. Bonow, Pieter Kappetein, Volkmar Falk, Eric Velazquez, Anno Diegeler, Holger Sigusch

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

89 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)964-976
Number of pages13
JournalJournal of the American College of Cardiology
Volume73
Issue number8
DOIs
StatePublished - Mar 5 2019

Keywords

  • heart team
  • prognosis
  • survival benefit

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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