Case analysis reveals optimal treatment strategy for multivessel disease, suggesting careful decision-making is crucial.
We present a case of a 71-year-old gentleman who suffered an inferoposterior ST elevation myocardial infarction treated with thrombolytic therapy where coronary angiography showed triple vessel disease and coronary artery bypass graft (CABG) was suggested. Based on the results of coronary physiology and non-significant values of FFR, Heart team denied revascularization and recommended medical therapy. Data from 11 randomized studies involving more than 11,000 patients comparing PCI to CABG in patients with multivessel disease (MVD) showed pronounced benefit of surgical revascularization in patients with more complex coronary anatomy (higher SYNTAX score) and diabetes. If there is a complex MVD with left main stenosis, the advantage should be given to CABG, as well as in the case of complex MVD and diabetes, while PCI has an advantage in patients with lower SYNTAX score, the ones with advanced age and comorbidities where PCI would offer faster postprocedural recovery. In retrospective analysis by Basman et al., patients subjected to hybrid revascularization techniques had similar mortality as patients that underwent CABG or multivessel PCI and similar incidence of composite outcomes.
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Ilić et al. (2022) studied this question.
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