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Active and Passive Vaccination for Pulmonary Arterial Hypertension: A Novel Therapeutic Paradigm Characteristics of stent thrombosis in bifurcation lesions analysed by optical coherence tomography Diagnostic Performance of Angiogram-Derived Fractional Flow Reserve: A Pooled Analysis of 5 Prospective Cohort Studies Long-term outcomes after treatment of bare-metal stent restenosis with paclitaxel-coated balloon catheters or everolimus-eluting stents: 3-year follow-up of the TIS clinical study Local Low Shear Stress and Endothelial Dysfunction in Patients With Nonobstructive Coronary Atherosclerosis Utilization and Outcomes of Measuring Fractional Flow Reserve in Patients With Stable Ischemic Heart Disease Circulating Plasma microRNAs In Systemic Sclerosis-Associated Pulmonary Arterial Hypertension Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies Genetic analyses in a cohort of 191 pulmonary arterial hypertension patients Impact of low tissue backscattering by optical coherence tomography on endothelial function after drug-eluting stent implantation
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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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