Coronary artery bypass grafting versus percutaneous coronary intervention in complex coronary artery disease: looking beyond clinical end-points

The choice of optimal revascularization techniques for complex coronary artery disease (CAD), either unprotected left main (UPLM) or multi-vessel disease (MVD), has been a matter of debate for the last two decades. Initially, randomized controlled trials (RCTs) demonstrated a significant mortality benefit of coronary artery bypass grafting (CABG) over medical therapy in patients with complex CAD (1). However, percutaneous coronary intervention (PCI) with balloon angioplasty alone or bare metal stent (BMS) was limited by higher rates of adverse events due to restenosis when compared to CABG (2). Since then, PCI has evolved in both stent technology and delivery techniques, and drug eluting stents (DES) have been shown to decrease risk of revascularization compared with BMS (3). Therefore, further research has focused on comparing PCI using DES versus CABG for patients with complex CAD.