Key result
Surgical revascularization for multivessel CAD lacks a precise functional assessment algorithm despite widespread global use.
Why the study?
A precise treatment algorithm for multivessel stable CAD is unavailable, leaving the extent and timing of revascularization as well as criteria for withholding surgery unclear.
This review highlights the ongoing uncertainty and lack of precise algorithms for revascularization strategies in patients with stable multivessel coronary artery disease.
Variability in multivessel CAD revascularization without functional algorithms warrants cautious decision-making; leaves open need for prospective trials to define standards.
World statistics data suggest that the surgical revascularization of the myocardium in multivessel coronary artery disease is performed in 40 to 60% of cases. However, severity of coronary artery disease is often evaluated through the analysis of clinical presentation and selective coronary angiography (ICA) data without an assessment of the functional significance of stenosis. A precise algorithm for the treatment of patients with multivessel coronary artery disease and stable coronary artery disease is still unavailable, i.e. extent of revascularization, its time, and criteria for complete withholding of surgical treatment remain unclear. Many factors affect myocardial blood supply in multivessel disease including the type of blood supply to the heart, presence of scar and collaterals, diameter of the affected artery, and presence of microvascular dysfunction. All these factors require rational and intelligent approach to establishing the optimal tactics. In this review, the authors identified discussion vector and presented their original opinion on the advisability/unreasonableness of approaches to revascularization in patients with multivessel coronary disease based on published clinical trials and current recommendations. In addition, we analyzed the existing data, identified the missing information, and proposed the prospects for possible new clinical studies in this scientific field.
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Obedinskiy et al. (2022) conducted a review in Multivessel coronary artery disease and stable coronary artery disease. Surgical revascularization was evaluated. Surgical revascularization for multivessel coronary artery disease is performed in 40 to 60% of cases globally, though a precise treatment algorithm incorporating functional assessment remains unavailable.
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