When should percutaneous coronary intervention (PCI) be considered as an alternative to coronary artery bypass grafting (CABG)?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Although CABG has been considered the standard of care for patients with unprotected left main CAD (ie, patients without prior CABG or a patent graft to the left anterior descending [LAD] or left circumflex artery), PCI to improve survival is a reasonable alternative to CABG in selected stable patients who have ≥50% diameter stenosis and either of the following [3] :

  • Anatomic conditions associated with a low risk of PCI procedural complications and a high likelihood of good long-term outcome (eg, stenosis of the ostium or trunk vs distal bifurcation or trifurcation stenoses)
  • Clinical characteristics that predict a significantly higher risk of adverse surgical outcomes

In addition, the patient’s ability to tolerate and comply with dual antiplatelet therapy is a consideration in the choice of PCI rather than CABG.

Although PCI is generally an acceptable alternative revascularization strategy compared to CABG, several studies have found a higher rate of repeat revascularization in patients who underwent PCI. [4, 5, 6]

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