Coronary artery bypass grafting versus percutaneous transcatheter coronary interventions: analysis of outcomes in myocardial revascularization

Coronary artery disease (CAD) is the leading cause of mortality over much of the globe, with over 7 million deaths worldwide attributed to CAD annually. The disease burden is particularly significant in the United States, where 1 in 3 Americans older than 20 years have some form of cardiovascular disease. In Europe, there are over 48 million people described as having ischemic cardiovascular disease. Heart disease remains the number one cause of mortality worldwide. Optimization of medical therapy and modification of risk factors remain the foundation of management of CAD, as reflected in the landmark Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial.5 A sizeable number of patients also will require revascularization either by coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI). However, revascularization strategies, although effective, play only a role in the overall strategy toward appropriate management of stable CAD therapy. The situation is somewhat different in unstable CAD; myocardial infarction (MI) as primary revascularization modifies outcomes and is potentially lifesaving. The evaluation, management, and ongoing scientific investigation into the care of patients requiring coronary revascularization is evolving at a brisk pace and frequently is shifting. This article will review contemporary guidelines on revascularization from the United States and Europe, appraise the current literature on patient-specific and procedure-specific considerations to revascularization, and discuss relevant considerations in the use of antiplatelet therapies germane to both surgical and percutaneous coronary revascularization.