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Impact of Myocardial Scar on Prognostic Implication of Secondary Mitral Regurgitation in Heart Failure Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis Heart Failure With Preserved Ejection Fraction in the Young A Randomized Study of Distal Filter Protection Versus Conventional Treatment During Percutaneous Coronary Intervention in Patients With Attenuated Plaque Identified by Intravascular Ultrasound Fluid Volume Overload and Congestion in Heart Failure: Time to Reconsider Pathophysiology and How Volume Is Assessed Economic and Quality-of-Life Outcomes of Natriuretic Peptide–Guided Therapy for Heart Failure Temporal Trends in Inpatient Use of Intravascular Imaging Among Patients Undergoing Percutaneous Coronary Intervention in the United States IVUS Guidance for Coronary Revascularization: When to Start, When to Stop? Role of Proximal Optimization Technique Guided by Intravascular Ultrasound on Stent Expansion, Stent Symmetry Index, and Side-Branch Hemodynamics in Patients With Coronary Bifurcation Lesions Stage B heart failure: management of asymptomatic left ventricular systolic dysfunction
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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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