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Patients with major or symptomatic coronary artery disease (CAD) commonly undergo revascularization--either with CABG surgery, which has been the mainstay of revascularization for more than half a century, or with percutaneous coronary intervention (PCI), which has become the more-commonly used strategy in the past decade. PCI has been tested in more randomized clinical trials than any other procedure in contemporary practice. In general, PCI is the preferred option for treating patients with simple coronary artery lesions and CABG surgery remains the standard of care for patients with complex CAD. Technical advancements in PCI and CABG surgery make comparisons of historical data for these strategies difficult. In this Review, we evaluate the evidence-based use of PCI and CABG surgery in treating patients with multivessel and unprotected left main stem disease and for specific patient groups, including those with diabetes mellitus, chronic heart failure, or chronic kidney disease. Finally, we highlight the available tools to aid decision-making, including clinical guidelines, risk scoring systems, and the role of the 'heart team'.

Original publication

DOI

10.1038/nrcardio.2013.138

Type

Journal article

Journal

Nat Rev Cardiol

Publication Date

11/2013

Volume

10

Pages

635 - 647

Keywords

Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Decision Support Techniques, Humans, Patient Selection, Percutaneous Coronary Intervention, Predictive Value of Tests, Risk Factors, Severity of Illness Index, Treatment Outcome