ABSTRACT
Coronary artery bypass grafting (CABG) has historically been regarded as the most appropriate strategy for the management of patient with extensive coronary disease. However, percutaneous coronary intervention (PCI) has emerged as an alternative that has been adopted in increasingly complex patient subsets. Whether PCI or CABG is preferable depends on lesion characteristics and patient co-morbidities. However, PCI and CABG outcomes have converged signifi cantly over the last decade and thus the indication for PCI is expanding. While bypass surgery has seen less spectacular advances than PCI, technical improvements that reduce the invasiveness of the procedure and the advent of off-pump bypass have reinvigorated this fi eld. Off-pump surgery should be performed more often and complete arterial revascularization is encouraged. Further randomized trials, comparing current state of the art surgical techniques with percutaneous intervention, in complex patient subsets, are warranted.
