Multivessel disease: from reasonably incomplete to functionally complete revascularization.

Soon after the introduction of coronary artery bypass surgery, the completeness of revascularization became a matter of concern. Several early surgical studies confirmed the belief that better clinical outcomes were obtained when each and every angiographically visible stenosis was bypassed by a distal anastomosis.1,2 Similarly, among patients with multivessel disease treated with percutaneous coronary intervention (PCI), complete revascularization was found to provide a significant advantage over incomplete revascularization in terms of reintervention, myocardial infarction, and death.3,4 However, a careful analysis of surgically treated multivessel disease patients in the Bypass Angioplasty Revascularization Investigation (BARI) trial showed that 1 graft to any system other than the left anterior descending confers no long-term advantage over PCI and may actually be deleterious.5