Choice between coronary artery bypass grafting and percutaneous coronary intervention.


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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