Abstract：
OBJECTIVE: The optimal revascularization strategy for coronary artery disease depends on various factors, such as disease complexity, patient characteristics, and preferences. Including a heart team in complex cases is crucial to ensure optimal outcomes. Decision-making between percutaneous coronary intervention and coronary artery bypass grafting must consider each patient\'s clinical profile and coronary anatomy. While current practice guidelines offer some insight into the optimal revascularization approach for the various phenotypes of coronary artery disease, the evidence to support either strategy continues to evolve and grow. Given the large amount of contemporary data on revascularization, this review aims to comprehensively summarize the literature on coronary artery bypass grafting and percutaneous coronary intervention in patients across the spectrum of coronary artery disease phenotypes.
RESULTS: Contemporary evidence suggests that for patients with triple vessel disease, coronary artery bypass grafting is preferred over percutaneous coronary intervention due to better long-term outcomes, including lower rates of death, myocardial infarction, and target vessel revascularization. Similarly, for patients with left main coronary artery disease, both percutaneous coronary intervention and coronary artery bypass grafting can be considered, as they have shown similar efficacy in terms of major adverse cardiac events, but there may be a slightly higher risk of death with percutaneous coronary intervention. For proximal left anterior descending artery disease, both percutaneous coronary intervention and coronary artery bypass grafting are viable options, but coronary artery bypass grafting has shown lower rates of repeat revascularization and better relief from angina. The Synergy Between PCI with Taxus and Cardiac Surgery score can help in decision-making by predicting the risk of adverse events and guiding the choice between percutaneous coronary intervention and coronary artery bypass grafting. European and American guidelines both agree with including a heart team that can develop and lay out individualized, optimal treatment options with respect for patient preferences. The debate between coronary artery bypass grafting versus percutaneous coronary intervention in multiple different scenarios will continue to develop as technology and techniques improve for both procedures. Risk factors, pre, peri, and post-procedural complications involved in both revascularization strategies will continue to be mitigated to optimize outcomes for those patients for which coronary artery bypass grafting or percutaneous coronary intervention provide ultimate benefit. Methods to avoid unnecessary revascularization continue to develop as well as percutaneous technology that may allow patients to avoid surgical intervention when possible. With such changes, revascularization guidelines for specific patient populations may change in the coming years, which can serve as a limitation of this time-dated review.
RESULTS: Contemporary evidence suggests that for patients with triple vessel disease, coronary artery bypass grafting is preferred over percutaneous coronary intervention due to better long-term outcomes, including lower rates of death, myocardial infarction, and target vessel revascularization. Similarly, for patients with left main coronary artery disease, both percutaneous coronary intervention and coronary artery bypass grafting can be considered, as they have shown similar efficacy in terms of major adverse cardiac events, but there may be a slightly higher risk of death with percutaneous coronary intervention. For proximal left anterior descending artery disease, both percutaneous coronary intervention and coronary artery bypass grafting are viable options, but coronary artery bypass grafting has shown lower rates of repeat revascularization and better relief from angina. The Synergy Between PCI with Taxus and Cardiac Surgery score can help in decision-making by predicting the risk of adverse events and guiding the choice between percutaneous coronary intervention and coronary artery bypass grafting. European and American guidelines both agree with including a heart team that can develop and lay out individualized, optimal treatment options with respect for patient preferences. The debate between coronary artery bypass grafting versus percutaneous coronary intervention in multiple different scenarios will continue to develop as technology and techniques improve for both procedures. Risk factors, pre, peri, and post-procedural complications involved in both revascularization strategies will continue to be mitigated to optimize outcomes for those patients for which coronary artery bypass grafting or percutaneous coronary intervention provide ultimate benefit. Methods to avoid unnecessary revascularization continue to develop as well as percutaneous technology that may allow patients to avoid surgical intervention when possible. With such changes, revascularization guidelines for specific patient populations may change in the coming years, which can serve as a limitation of this time-dated review.
摘要：
目的：冠状动脉疾病的最佳血运重建策略取决于各种因素，比如疾病的复杂性，患者特征,和偏好。在复杂的情况下包括心脏团队对于确保最佳结果至关重要。经皮冠状动脉介入治疗和冠状动脉旁路移植术之间的决策必须考虑每个患者的临床资料和冠状动脉解剖结构。虽然目前的实践指南为冠状动脉疾病的各种表型的最佳血运重建方法提供了一些见解，支持这两种策略的证据都在不断发展和增长。鉴于大量的当代血运重建数据，本文旨在全面总结冠状动脉旁路移植术和经皮冠状动脉介入治疗在不同冠状动脉疾病表型患者中的应用。
结果：当代证据表明，对于患有三支血管疾病的患者，冠状动脉旁路移植术优于经皮冠状动脉介入治疗，因为它具有更好的长期预后，包括较低的死亡率，心肌梗塞,和目标血管血运重建。同样，对于左主干冠状动脉疾病的患者，可以考虑经皮冠状动脉介入治疗和冠状动脉旁路移植术，因为他们在主要不良心脏事件方面表现出相似的功效，但经皮冠状动脉介入治疗的死亡风险可能略高.对于左前降支近端疾病，经皮冠状动脉介入治疗和冠状动脉旁路移植术都是可行的选择，但是冠状动脉旁路移植术显示重复血运重建的发生率较低，心绞痛的缓解更好。PCI与Taxus和心脏外科手术评分之间的协同作用可以通过预测不良事件的风险并指导经皮冠状动脉介入治疗和冠状动脉旁路移植术之间的选择来帮助决策。欧洲和美国的指导方针都同意包括一个可以开发和设计个性化的心脏团队，根据患者偏好的最佳治疗选择。随着技术和技术的改进，冠状动脉旁路移植术与经皮冠状动脉介入治疗在多种不同情况下之间的争论将继续发展。危险因素,pre,peri,两种血运重建策略所涉及的术后并发症将继续得到缓解,以优化冠状动脉旁路移植术或经皮冠状动脉介入治疗最终获益的患者的结局.避免不必要的血运重建的方法以及经皮技术的不断发展，可以使患者在可能的情况下避免手术干预。有了这样的变化,针对特定患者人群的血运重建指南可能会在未来几年发生变化，这可以作为这个时间日期审查的限制。
结果：当代证据表明，对于患有三支血管疾病的患者，冠状动脉旁路移植术优于经皮冠状动脉介入治疗，因为它具有更好的长期预后，包括较低的死亡率，心肌梗塞,和目标血管血运重建。同样，对于左主干冠状动脉疾病的患者，可以考虑经皮冠状动脉介入治疗和冠状动脉旁路移植术，因为他们在主要不良心脏事件方面表现出相似的功效，但经皮冠状动脉介入治疗的死亡风险可能略高.对于左前降支近端疾病，经皮冠状动脉介入治疗和冠状动脉旁路移植术都是可行的选择，但是冠状动脉旁路移植术显示重复血运重建的发生率较低，心绞痛的缓解更好。PCI与Taxus和心脏外科手术评分之间的协同作用可以通过预测不良事件的风险并指导经皮冠状动脉介入治疗和冠状动脉旁路移植术之间的选择来帮助决策。欧洲和美国的指导方针都同意包括一个可以开发和设计个性化的心脏团队，根据患者偏好的最佳治疗选择。随着技术和技术的改进，冠状动脉旁路移植术与经皮冠状动脉介入治疗在多种不同情况下之间的争论将继续发展。危险因素,pre,peri,两种血运重建策略所涉及的术后并发症将继续得到缓解,以优化冠状动脉旁路移植术或经皮冠状动脉介入治疗最终获益的患者的结局.避免不必要的血运重建的方法以及经皮技术的不断发展，可以使患者在可能的情况下避免手术干预。有了这样的变化,针对特定患者人群的血运重建指南可能会在未来几年发生变化，这可以作为这个时间日期审查的限制。
