Stent versus CABG to Treat Multivessel Coronary Artery Disease

Cardiac revascularization in patients with significant coronary artery disease (CAD) is an important therapeutic intervention to improve symptoms and prognosis. Along with revascularization, patients should receive guideline direct medical therapy.

The best current revascularization results achieved with percutaneous coronary intervention (PCI) are with new-generation drug-eluting stents (DES) and for coronary artery bypass grafting (CABG) with maximal use of arterial grafts. The best option is still a large question as many different patient characteristics exist. About 25% of all patients who undergo multi-vessel revascularization have diabetes.

Studies point to CABG as preferred treatment

In Spring 2018, a pooled analysis of individual patient data from 11 randomized trials compared the two revascularization strategies and pointed towards a survival benefit in those who had undergone CABG.

Additionally early this year, for individuals with a left ventricular ejection fraction (LVEF) less than 35% and concomitant diabetes, PCI as compared with CABG was associated with an increased MACCE risk, including greater risks of death, MI and repeat revascularization, over a mean follow-up period of more than four years.

Thus suggesting again, that in multivessel CAD, CABG is preferred for an attempt to completely revascularize the myocardium if able.

The multitude of studies for revascularization comparing PCI and CABG cannot provide a single solution for the entire spectrum of patients with significant CAD. Nevertheless, the data supports that CABG results in a more complete revascularization than PCI, particularly in complex multi-vessel CAD, and patients with reduced ejection fraction.

Contact us for more information

For more information on this topic, other questions related to cardiac care or to refer a patient, please contact Bryan Heart at 402-483-3333.