Meditations on secondary revascularisation in the aftermath of the SYNTAX trial (original) (raw)

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2009

Abstract

Many patients will experience a return of symptoms after their initial revascularisation procedure necessitating secondary revascularisation (SR). The options for this second procedure are inherently influenced by the primary method adopted for revascularisation. Patients with single vessel disease are most suited to percutaneous coronary intervention (PCI) for both primary and secondary revascularisation. The arrival of drug eluting stents, and evidence from trials of highly select populations has threatened the place of coronary artery bypass grafting (CABG) as the preferred method of revascularisation in those with multivessel disease. At present, and without robust evidence, PCI is increasingly being used to treat highly complex lesions, such that many question whether CABG is still has a role in primary revascularisation. The consequence for SR is that currently it is increasingly likely to be in response to in-stent restenosis, whereby previously it was performed in those with...

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