Choice between coronary artery bypass grafting and percutaneous coronary intervention.

April 9, 2019 by Dr. Clemens Leave a Comment

by Саrdiac Anesthesiologist

FAVOURS percutaneous coronary intervention (PCI):

Clinical characteristics:

Presence of severe co-morbidity (not adequately reflected by scores)
Advanced age/frailty/reduced life expectancy
Restricted mobility and conditions that affect the rehabilitation process

Anatomical and technical aspects:

Multivessel coronary artery disease (MVD) with SYNTAX score 0–22
Anatomy likely resulting in incomplete revascularization with CABG (coronary artery bypass grafting) due to poor quality or missing conduits
Severe chest deformation or scoliosis
Sequelae of chest radiation
Porcelain aorta (consider no-touch off-pump CABG in case of porcelain aorta).

FAVOURS CABG (coronary artery bypass grafting):

Clinical characteristics:

Diabetes
Reduced LV (left ventricular) function (ejection fraction ≤ 35%)
Contraindication to DAPT (dual antiplatelet therapy)
Recurrent diffuse in-stent restenosis

Anatomical and technical aspects:

Multivessel coronary artery disease (MVD) with SYNTAX score ≥ 23
Anatomy likely resulting in incomplete revascularization with PCI
Severely calcified coronary artery lesions limiting lesion expansion

Need for concomitant interventions:

Ascending aortic pathology with indication for surgery
Concomitant cardiac surgery

source: 2018 ESC/EACTS Guidelines on myocardial

revascularization

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