CABG versus PCI: Lessons from randomized trials and observational registries

Medical, percutaneous, and surgical therapies for coronary atherosclerotic disease are developing rapidly, with many new pivotal trials demonstrating technological breakthroughs in pharmacologic therapy, improvements in catheter and stent platforms, and advances in surgical technique. While traditional treatment guidelines generally recommend coronary artery bypass grafting surgery for three vessel and left main disease, they do not take into account several of the recent data. Use of these newer technologies has led to numerous new randomized trials that have challenged the older guideline recommendations. Considering such complex and, sometimes conflicting data, determination of the most appropriate treatment remains challenging. In this chapter, we examine important old and new data and trials comparing contemporary stent technology and coronary artery bypass surgery, discuss the most recent revascularization guidelines, and conclude with future steps and suggested revascularization recommendations that take the new data into account.