What is the role of revascularization in the treatment of coronary artery atherosclerosis?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Answer

Revascularization therapies for symptomatic or ischemia-producing atherosclerotic lesions include percutaneous approaches and open heart surgery. For a detailed discussion of these approaches, see Percutaneous Transluminal Coronary Angioplasty and Comparison of Revascularization Procedures in Coronary Artery Disease.

Long-term mortality has been similar after CABG and PCI in most patient subgroups with multivessel CAD; therefore, the choice of treatment typically depends on patient preferences for other outcomes. Exceptions to this are patients with diabetes and those age 65 years or older; Hlatky et al found CABG to be a superior option in these subgroups, because of lower mortality. [88]

The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) study determined that in high- and intermediate-risk patients with 3-vessel disease, the rates of revascularization and of major adverse cardiac and cerebrovascular events were significantly higher in patients who had undergone PCI than in those who had undergone CABG. [2, 3] The study also found that PCI and CABG were equally effective in the treatment of low-risk patients with 3-vessel disease and in low- and intermediate-risk patients with left main CAD.

In a more recent study that compared the long-term prognostic value of baseline (ss) and clinical SYNTAX scores (cSS) in 460 Turkish patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease who either underwent CABG (n = 214) or PCI (n = 246), investigators found that ss and cSS had prognostic value in the CABG group but not the PCI group. [89] Moreover, in the CABG group, cSS appeared to have more discriminative power than SS for long-term adverse effects.

Other revascularization techniques include transmyocardial laser revascularization.


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