Abstrait

Revascularization for stable ischemic heart disease: are there new parallels between percutaneous coronary intervention and coronary artery bypass grafting?

AN Buch, C Chen & TB Ferguson Jr

In patients with stable ischemic heart disease, revascularization is undertaken when optimal medical therapy fails, using percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) as appropriate and determined by the local Heart Team. For years, both revascularization strategies have been based on angiographically assessed anatomy alone. Now, using anatomy and physiology to guide intervention has been definitively shown to be superior to an anatomy-only approach in multicenter trials in PCI, documenting the importance of the regional myocardial perfusion status on outcomes. Since cath-lab physiologic evaluation is a pre-intervention assessment that impacts PCI outcomes, is regional myocardial perfusion important to CABG outcomes as well? Novel intraoperative imaging data are presented to document that in stable ischemic heart disease, competitive flow, graft patency and late mortality in CABG are influenced by the regional myocardial perfusion status of the grafted vessels. This new information should improve the outcomes of CABG as has occurred with PCI.