Is Angioplasty Able to Become the Gold Standard of Treatment Beyond Bypass Surgery for Patients With Multivessel Coronary Artery Disease?: Therapeutic Strategies for 3-Vessel Coronary Artery Disease: OPCAB vs PCI (PCI-Side)

This article reviews the treatment of patients with multivessel coronary artery disease (CAD). Percutaneous coronary intervention (PCI) has been challenging coronary artery bypass grafting (CABG) as the gold standard of care for patients with multivessel disease; however, the application of PCI to t...

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Bibliographic Details
Published in:Circulation Journal 2010, Vol.74(12), pp.2744-2749
Main Authors: Takayama, Tadateru, Hiro, Takafumi, Hirayama, Atsushi
Format: Article
Language:English
Subjects:
Angioplasty - methods
Coronary Angiography
Coronary Artery Bypass - methods
Coronary artery bypass grafting
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - mortality
Coronary Artery Disease - surgery
Drug-eluting stents
Female
Humans
Intravascular ultrasound
Male
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - mortality
Myocardial Infarction - surgery
Percutaneous coronary intervention
Thrombosis - mortality
Thrombosis - prevention & control
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Summary:This article reviews the treatment of patients with multivessel coronary artery disease (CAD). Percutaneous coronary intervention (PCI) has been challenging coronary artery bypass grafting (CABG) as the gold standard of care for patients with multivessel disease; however, the application of PCI to these patients has been mainly limited by restenosis. Up to the beginning of the 2000s, many large-scale, randomized trials addressed this issue by comparing CABG to PCI with balloon angioplasty or bare metal stents in not only Western countries but also in Asian countries. These studies demonstrated similar rates of all-cause death and myocardial infarction in both groups, although the need for revascularization remained significantly lower in the CABG group. PCI with drug-eluting stents (DES) is safe and may represent a viable alternative to CABG for selected patients with diabetes and multivessel CAD. Moreover, DES implantation under intravascular ultrasound guidance and with fractional flow reserve might have the potential to influence treatment strategy and reduce both DES thrombosis and repeat revascularization. The evolution of DES and advanced vascular imaging would mean that PCI continues to challenge CABG as treatment of choice for patients who need revascularization for a better prognosis. (Circ J 2010; 74: 2744-2749)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-10-1012