Evidence based strategy of coronary revascularization: the Answer to the paradigm shift in the treatment of chronic coronary artery disease

ABSTRACT

The choice of treatment strategy from medical therapy, percutaneous transluminal coronary angioplasty [PTCA], and coronary artery grafting [CABG] greatly influences outcome of patients with chronic coronary artery disease. Recent randomized trials and registries information as to the judgment of optimal treatment strategy. These studies have shown that best outcome is likely when 1-or2-vessel disease without proximal left anterior descending artery [LAD] stenosis is treated medically. 2-vessel disease with proximal LAD stenosis or 3-vessel disease without proximal LAD stenosis is treated by PTCA or CABG. 3-vessel disease with proximal LAD stenosis or left coronary stenosis is treated by CABG. CABG is preferred to PTCA in diabetic patients and patients with decreased left ventricular function. Recent advances in the treatment coronary artery disease are also reviewed as they influence current treatment strategy