Multivessel coronary atherosclerotic disease in exclusive pharmacological treatment: case report and a critical literature review

Three-vessel coronary atherosclerotic disease (CAD) presents a clinical challenge in managing heart cardiac patients, especially when they resist undergoing interventional therapies such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). This article presents a challeging case report of a patient with three-vessel CAD who refused invasive therapies and was managed solely through medical treatment. It also critically reviews the literature on the atual benefits and drawbacks of medical treatment versus interventional therapies in multivessel CAD. The recommendations from Cardiology Societies, as well as data from randomized controlled trials (RCTs), were critically analyzed, comparing outcomes such as mortality, morbidity, and quality of life, in order to assess the actual magnitude of benefit across different therapeutic modalities. In selected cases, the current optimized medical therapy (OMT) alone may be a viable alternative, particularly for patients who refuse invasive interventions.