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Editorial

Pitfalls Assessing the Role of Drug-Eluting Stents in Multivessel Coronary Disease

Department of Cardiac and Vascular Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

^_* Address correspondence to Dr Desai, Department of Cardiac Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room H410, Toronto, Ontario, M4P 1S7, Canada (Email: nimesh.desai@utoronto.ca).

The first 20% of the full text of this article appears below.

The role of percutaneous coronary intervention (PCI) in the treatment of multivessel coronary artery disease remains intensely debated and highly editorialized. Although an increasing number of patients with multivessel disease have been treated with PCI, controversy remains regarding the evidence to support such a strategy. With the innovation of drug-eluting stents (DES), a vast expansion in the proportion of patients with multivessel disease undergoing PCI occurred with a subsequent decline in coronary artery bypass surgery procedures. Recent concerns over the safety and clinical efficacy of DES have prompted significant re-evaluation of revascularization strategies.

The scientific rationale for coronary artery bypass grafting (CABG) in patients with multivessel disease regarding medical therapy is based on several important randomized clinical trials summarized in a meta-analysis article by Yusuf and colleagues [1] in 1994. More recently, the Bypass Angioplasty Randomized Investigation (BARI) trial demonstrated a survival benefit among diabetics with multiple-vessel disease treated with bypass surgery in comparison with balloon angioplasty [2]. From these studies, we have derived the majority of indications for contemporary CABG—double or triple vessel disease including high grade proximal left anterior descending coronary artery stenosis, triple vessel disease in diabetic patients, triple vessel disease in the setting of left ventricular dysfunction, left main disease and intractable angina after failure of other therapies.

The scientific rationale for increasing the use of PCI with DES in patients with multivessel coronary disease has been extrapolated from clinical trials including the BARI trial assessing balloon angioplasty and the Arterial Revascularization Therapies Study [ARTS] assessing bare metal stents [2, 3]. The key finding in both of these studies was that PCI . . . [Full Text of this Article]

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