Franz Josef Neumann and Heinz Joachim Bttner


■ When coronary revascularization is considered, prognostic and symptomatic indications need to be distinguished.

■ In general, percutaneous coronary intervention (PCI) for single-vessel disease is justified only if improvement of symptoms can be anticipated.

■ In patients with multivessel disease without relevant left main coronary artery involvement and without diabetes mellitus, survival after PCI is similar to that after coronary artery bypass grafting (CABG), provided that complete revascularization can be achieved.

■ In patients with diabetes mellitus, it is unclear whether multivessel PCI can achieve a prognostic benefit similar to that of CABG. Depending on the chances for success and the risks for surgery, multivessel PCI may offer a reasonable option in diabetic patients.

■ Currently available evidence does not allow proposing PCI for distal left main coronary artery disease in patients who are good candidates for surgery. PCI appears to be an acceptable alternative to CABG in poor surgical candidates.

■ In many instances, individualized decisions must be taken jointly by the cardiac surgeon and the interventional cardiologist.

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