Practical Management of Multivessel Coronary Artery Disease

Multivessel coronary artery disease remains one of the most challenging cardiovascular diseases to manage. Selecting the optimal revascularization strategy requires multidisciplinary Heart Team discussion that incorporates coronary anatomy, clinical risk factors, and patient preferences into the decision-making process. Clinical guidelines provide a valuable framework for standardized, evidence-based care with reduced practice variability. However, many landmark trials enrolled highly selected populations and were conducted before the widespread adoption of contemporary revascularization techniques, including physiologic lesion assessment, intracoronary imaging, and modern arterial grafting strategies. Reflecting a collaborative Heart Team perspective, this state-of-the-art review from the American College of Cardiology Interventional Section Leadership Council and Cardiac Surgery Leadership Council summarizes contemporary evidence, reviews areas of ongoing controversy, and provides practical guidance for managing patients with multivessel coronary artery disease in clinical situations that extend beyond the scope of current guideline recommendations.