Optimal revascularization strategies for multivessel coronary artery disease
Current Opinion in Cardiology , Volume 21 - Issue 6 p. 595- 601
PURPOSE OF REVIEW: The aim of this article is to review the current status of optimal revascularization strategies in patients presenting with multivessel coronary artery disease. RECENT FINDINGS: Coronary artery bypass surgery is the gold standard for patients with multivessel disease. Recent developments in the interventional field, like drug-eluting stents, which significantly reduced restenosis and the need for repeat revascularizations, have cut back one of the largest limitations of percutaneous coronary intervention. SUMMARY: There is currently little evidence to believe that in a general population, opting for either coronary artery bypass surgery or percutaneous coronary intervention would imply a better long-term survival. Coronary artery bypass surgery is still associated with higher rates of complete revascularization and a higher durability than percutaneous coronary intervention, resulting in lower rates of repeat revascularization. The current evidence, however, is based on sub-optimal inconclusive data from single center or multicenter registries. Until the results of several dedicated ongoing randomized trials are presented, the choice for a revascularization strategy should be made not only on the basis of feasibility but also by taking into account each patient's co-morbidities and risk factors. Careful monitoring of glycemic control and lipid concentrations and an optimal pharmacological treatment are at least as important in achieving an optimal outcome.
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Daemen, J, & Serruys, P.W.J.C. (2006). Optimal revascularization strategies for multivessel coronary artery disease. Current Opinion in Cardiology (Vol. 21, pp. 595–601). doi:10.1097/01.hco.0000245738.40088.70