Decision Making Between Percutaneous Coronary Intervention or Bypass Surgery in Multi-vessel Coronary Disease Elección de intervención coronaria percutánea o bypass en la enfermedad coronaria multivaso

The current European Society of Cardiology guidelines for revascularization confer a Class I indication (level of evidence A) for coronary artery bypass grafting (CABG) in multi-vessel coronary artery disease (MVD). However, due to recent advances in percutaneous coronary intervention (PCI), with new generation drug-eluting stents (DES) and more potent antiplatelet agents, in addition to increasing operator experience and availability of adjunctive tools (intravascular ultrasound and fractional flow reserve guidance), the frequency of PCI for MVD has increased. Indeed, there is a Class IIa (level of evidence B) indication for PCI with a ‘‘SYNergy between PCI with TAXus and cardiac surgery’’ (SYNTAX) score 22 in those patients with chronic stable MVD. Both clinical and anatomical characteristics of the patient have to be taken into account in the decision making regarding the optimal method of revascularization for a patient with MVD. Careful risk stratification and active discussion with a multidisciplinary Heart Team is recommended in this patient subset. Not all MVD is the same and as such each patient should be assessed on an individual basis to ensure that the most appropriate revascularization modality is chosen to provide favourable longterm outcomes. Individuals with MVD presenting as an acute coronary syndrome (ACS) require clinical decision making that also takes into account the urgency of revascularization, and such studies have not been included in this article. The aim of this editorial is to discuss factors influencing the decision making between PCI and CABG in patients with chronic MVD.