Author + information
- Received September 14, 2018
- Revision received November 9, 2018
- Accepted November 26, 2018
- Published online February 25, 2019.
- Torsten Doenst, MD, PhDa,∗ (, )
- Axel Haverich, MD, PhDb,
- Patrick Serruys, MD, PhDc,
- Robert O. Bonow, MD, MSd,
- Pieter Kappetein, MD, PhDe,
- Volkmar Falk, MD, PhDf,
- Eric Velazquez, MDg,
- Anno Diegeler, MD, PhDh and
- Holger Sigusch, MDi
- aDepartment of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University of Jena, Jena, Germany
- bDepartment of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- cNational Heart and Lung Institute, Imperial College London, London, United Kingdom
- dDepartment of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- eDepartment of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- fDepartment of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
- gDepartment of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- hDepartment of Cardiac Surgery, Heart Center Bad Neustadt, Bad Neustadt, Germany
- iDepartment of Cardiology, Heinrich-Braun-Hospital, Zwickau, Germany
- ↵∗Address for correspondence:
Prof. Torsten Doenst, Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747 Jena, Germany.
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered revascularization procedures, but only CABG can prolong life in stable coronary artery disease. Thus, PCI and CABG mechanisms may differ. Viability and/or ischemia detection to guide revascularization have been unable to accurately predict treatment effects of CABG or PCI, questioning a revascularization mechanism for improving survival. By contrast, preventing myocardial infarction may save lives. However, the majority of infarcts are generated by non–flow-limiting stenoses, but PCI is solely focused on treating flow-limiting lesions. Thus, PCI cannot be expected to significantly limit new infarcts, but CABG may do so through providing flow distal to vessel occlusions. All comparisons of CABG to PCI or medical therapy that demonstrate survival effects with CABG also demonstrate infarct reduction. Thus, CABG may differ from PCI by providing “surgical collateralization,” prolonging life by preventing myocardial infarctions. The evidence is reviewed here.
Dr. Kappetein is an employee of Medtronic. Dr. Falk has received research or educational grants and/or fees for lecturing or consulting from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific, Berlin Heart, and Novartis Pharma. Dr. Velazquez has been a consultant to Novartis, Amgen, and Philips; and has received research funding from Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received September 14, 2018.
- Revision received November 9, 2018.
- Accepted November 26, 2018.
- 2019 American College of Cardiology Foundation
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