Choice of revascularization strategy for patients with coronary artery disease.

Abstract

SURGICAL CORONARY ARTERY BYpass grafting (CABG) was first performed in 1967 and percutaneous transluminal coronary artery angioplasty (PTCA) in 1977. Initially the 2 revascularization methods appeared complementary: the less invasive PTCA seemed suited for patients with limited lesions, and CABG for those with diffuse disease. The Duke University group, in a large prospective study, first established that PTCA achieved the greatest survival benefit in patients with a singlevessel disease other than proximal left anterior descending (LAD) artery stenosis, and CABG in those with multivessel disease or proximal LAD artery stenosis. Patients with 2-vessel disease or an isolated proximal LAD artery stenosis had similar results with either therapy. However, individual clinical variables, such as the characteristics of the stenosis, the patient’s ventricular function, and associated comorbidities, are often factored into the final decision about the method of revascularization. In the 1990s, a number of randomized trials attempted to refine the indications for PTCA vs CABG in patients who could concurrently be approached by both methods.