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J Am Coll Cardiol. 2019 Mar 5;73(8):964-976. doi: 10.1016/j.jacc.2018.11.053.

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

Author information

1
Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University of Jena, Jena, Germany. Electronic address: doenst@med.uni-jena.de.
2
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
3
National Heart and Lung Institute, Imperial College London, London, United Kingdom.
4
Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
5
Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
6
Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.
7
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
8
Department of Cardiac Surgery, Heart Center Bad Neustadt, Bad Neustadt, Germany.
9
Department of Cardiology, Heinrich-Braun-Hospital, Zwickau, Germany.

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.

KEYWORDS:

heart team; prognosis; survival benefit

PMID:
30819365
DOI:
10.1016/j.jacc.2018.11.053

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