Back to Journals » Research Reports in Clinical Cardiology » Volume 6

Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

Authors Burgess SN, Edmond J, Juergens CP, French J

Received 2 September 2014

Accepted for publication 2 December 2014

Published 16 June 2015 Volume 2015:6 Pages 57—71


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Richard Kones

Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French1

Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand

Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI) has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials.
Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG) and PCI, with particular reference to the landmark trials that inform practice guidelines.
Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era.
Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the patients with low Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac surgery score, rates of revascularization were significantly lower with CABG. The new 2014 European Society of Cardiology guidelines also reflect this.
Conclusion: The field of coronary revascularization is complex and constantly evolving. The best revascularization strategy for an individual patient must take into account clinical presentation, comorbidities, the extent and complexity of the coronary artery disease, and data from trials reflecting contemporary practice.


Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]