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Revascularization Strategies in Multivessel Coronary Artery Disease

  • Cristiano Giovanni Caputi
  • Fabrizio Ricci
  • Carlo De Innocentiis
  • Raffaele De Caterina
  • Marco Zimarino
Chapter

Abstract

Multivessel coronary artery disease (MVCAD) is traditionally defined as the presence of a ≥50% diameter stenosis in more than one epicardial vessel. It is documented in 40–60% of patients undergoing coronary angiography and, depending on the clinical presentation, is associated with adverse outcomes compared with single-vessel disease. The management of patients with MVCAD is influenced not only by the extent and severity of disease, but also by the clinical presentation, left ventricular systolic function, and the presence of comorbidities such as diabetes and chronic kidney disease.

In MVCAD, myocardial revascularization can be achieved by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), either on all diseased coronary segments (complete anatomical myocardial revascularization) or on selectively targeted lesions (incomplete myocardial revascularization). Complete revascularization confers a long-term prognostic benefit, but is technically more demanding and is associated with a higher rate of in-hospital events compared with incomplete revascularization. We provide a reappraisal of current knowledge and an account of unresolved issues concerning the completeness of myocardial revascularization, critically reviewing the concept of lesion and myocardial functional evaluation, and highlighting the importance of different clinical settings. For patients with MVCAD, the choice between PCI and CABG should depend not only on the adequacy of myocardial revascularization, but also on coronary anatomy, the ischemic burden, myocardial function, and the presence of comorbidities in specific clinical settings.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Cristiano Giovanni Caputi
    • 1
  • Fabrizio Ricci
    • 1
  • Carlo De Innocentiis
    • 1
  • Raffaele De Caterina
    • 1
  • Marco Zimarino
    • 1
  1. 1.Institute of Cardiology and Center of Excellence on Aging, “G. d’Annunzio” University – ChietiChietiItaly

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