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Joint consensus on the use of OCT in coronary bifurcation lesions by the European and Japanese bifurcation clubs Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity Coronary Flow Reserve in the Instantaneous Wave-Free Ratio/Fractional Flow Reserve Era: Too Valuable to Be Neglected A new optical coherence tomography-based calcium scoring system to predict stent underexpansion The impact of downstream coronary stenoses on fractional flow reserve assessment of intermediate left main disease Myocardial Blood Flow and Coronary Flow Reserve During 3 Years Following Bioresorbable Vascular Scaffold Versus Metallic Drug-Eluting Stent Implantation: The VANISH Trial Identification of High-Risk Plaques Destined to Cause Acute Coronary Syndrome Using Coronary Computed Tomographic Angiography and Computational Fluid Dynamics Therapeutic efficacy of paclitaxel-coated balloon for de novo coronary lesions with diameters larger than 2.8 mm Coronary fractional flow reserve in bifurcation stenoses: what have we learned?
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Review ArticleVolume 73, Issue 8, March 2019

JOURNAL：J Am Coll Cardiol. Article Link

PCI and CABG for Treating Stable Coronary Artery Disease

T Doenst, A Haverich, P Serruys et al. Keywords: heart team; prognosis; survival benefit

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.

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