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A Meta-Analysis of Contemporary Lesion Modification Strategies During Percutaneous Coronary Intervention in 244,795 Patients From 22 Studies Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review Canadian Multicenter Chronic Total Occlusion Registry: Ten-Year Follow-Up Results of Chronic Total Occlusion Revascularization Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus Transcatheter Mitral-Valve Repair in Patients with Heart Failure Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie? Thin Composite-Wire-Strut Zotarolimus-Eluting Stents Versus Ultrathin-Strut Sirolimus-Eluting Stents in BIONYX at 2 Years Ejection Fraction Pros and Cons: JACC State-of-the-Art Review Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction

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.