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Complete Revascularization: Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention

The concept of complete revascularization arose from the early studies on coronary artery bypass grafting (CABG) surgery whereby some publications demonstrated that patients who were completely revascularized enjoyed a mortality benefit over those who were incompletely revascularized, thus setting the standard for the field of CABG.1–3 Over the past 3 decades, CABG has evolved from saphenous vein grafting to more frequent use of arterial grafting, better perioperative management, development of a less invasive approach, and off-pump surgery as a genuine option. The development of percutaneous coronary interventions (PCIs) for the treatment of coronary stenosis has developed out of the treatment of single-vessel disease to become an alternative to CABG in the treatment of multivessel disease.4,5 PCI has progressed from balloon angioplasty to coronary stents,6,7 and now drug-eluting stents,8 with the simultaneous development of new devices to treat chronic total occlusions (CTOs). For both groups of patients treated by either CAGB or PCI, there is recognition that aggressive pharmacological secondary-prevention therapies such as statins and antiplatelet agents are beneficial and are now commonly used.

Despite the mantra of complete revascularization, none of the current guidelines set out by the American or European cardiology societies formally discuss the issue in detail. Although this topic has been addressed separately within each revascularization strategy, to date there has been only 1 report from a randomized trial that compared the end point of complete revascularization between CABG and PCI.9 This review will therefore address the issue separately for CABG and for PCI and finally provide a comparison of the 2 strategies.

There is no universal definition for what is meant by “complete” revascularization (Table 1). Different studies employ different definitions, and for that reason, comparisons between studies must be interpreted with caution. For example, revascularization may be declared complete if …