Percutaneous versus surgical coronary revascularization in the current era and beyond: Is the debate over?

Coronary artery disease is a leading cause of morbidity and mortality in developed countries around the globe. Coronary revascularization, either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) has been shown to be safe and effective in appropriately selected patients. Both revascularization strategies have undergone significant advancements, creating the need to (re) examine data from clinical studies and critically scrutinize existing guidelines in order to determine the optimal care for each individual patient. In this chapter, we will discuss the CABG and PCI in the current era, and highlight relative strengths and weaknesses of each approach. We will also discuss various risk-stratification scoring systems, and consider both procedures in the context of different demographic populations, including advanced age, gender, acute coronary syndromes, previous CABG, renal failure, diabetes mellitus and left main involvement. The continued development of objective patient-assessment tools to offer patient-tailored recommendation is critical. Moreover, novel therapeutic approaches and treatment regimens, such as a hybrid strategy, as well as techniques targeted at improving stent and graft patency will be evaluated. This synthesis of information will provide an essential framework for evidence-based approach of coronary revascularization in the current era and beyond.