Frank W. Britto, Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular INCOR – EsSalud, Lima, Perú
Myocardial revascularization is a key strategy to restore blood flow in patients with coronary artery disease, especially in those with symptoms refractory to medical treatment or a high risk of cardiovascular events. The two available techniques are percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The choice between them depends on factors such as anatomical complexity, comorbidities, and patient preferences, making shared decision-making essential. The SYNTAX study and its scoring system have facilitated risk stratification and treatment guidance; patients with left main or multivessel disease derive greater benefit from CABG, while PCI is more appropriate for less complex lesions. In chronic coronary disease, revascularization improves symptoms and quality of life, but its impact on survival depends on risk profile and ventricular function. The European guidelines have proposed a more unified classification of coronary syndromes, differentiating acute and chronic scenarios, while new research suggests that coronary anatomy, more than ischemia on imaging, should guide therapeutic strategy. In low-risk patients, optimal medical therapy is usually sufficient with revascularization reserved for refractory cases. In acute coronary syndromes, complete revascularization is crucial in ST-elevation myocardial infarction, though the evidence remains limited in other contexts. Individualized selection and multidisciplinary collaboration are essential to improve clinical outcomes.
Keywords: Myocardial ischemia. Angina pectoris. Acute coronary syndrome.