Which vessels to revascularize is always a question in a person with multi-vessel coronary artery disease of varying severity. Kim Y and colleagues [Impact of Ischemia-Guided Revascularization With Myocardial Perfusion Imaging for Patients With Multivessel Coronary Disease. J Am Coll Cardiol. 2012;60:181-190] addressed this issue in a retrospective analysis of over five thousand three hundred patients with multi-vessel coronary artery disease, of which nearly half underwent PCI (percutaneous coronary intervention) with DES (drug eluting stents) while a little more than half underwent coronary artery bypass grafting (CABG). The revascularization was done in the matched coronary artery with the perfusion abnormality noted on MPI (myocardial perfusion imaging). Myocardial perfusion imaging was done in over forty two percent of patients. MACCE (major adverse cardiac and cerebrovascular events) including death, myocardial infarction, stroke and repeat revascularization was lower in the ischemia guided group (16.2 percent versus 20.7 percent). The difference was mainly due to the lower rates of repeat revascularization (9.9 percent versus 22.8 percent). This difference was mostly in the PCI group, rather than the CABG group.
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