Surgical, medical, and percutaneous therapies for patients with multivessel coronary artery disease

Patients with multivessel coronary artery disease (CAD) are now faced with a number of treatment choices, including coronary artery bypass graft surgery, medical therapy, and percutaneous coronary interventions (using bare-metal or drug-eluting stents). Each carries certain benefits and risks: bypass surgery is favored in the subset of patients with multivessel disease and diabetes or impaired left ventricular systolic function who are able to receive a left internal mammary artery graft; medical therapy consisting of beta-blockers, angiotensin-converting enzyme inhibitors, statins, aspirin, and nitrates is offered to patients with stable angina. Percutaneous procedures have previously been limited in their efficacy by restenosis and resulting morbidity, but contemporary stenting procedures appear to show equivalent mortality and morbidity outcomes (to bypass surgery) at 5 years. Drug-eluting stents are the newest percutaneous technique and show significant reduction in restenosis compared with older catheter-based therapies, but further investigation is needed to definitively define the role of drug-eluting stents in the treatment of multivessel CAD. This review summarizes the data comparing medical, surgical, and percutaneous treatment approaches for patients with multivessel CAD.