Coronary Revascularization: Clinical Features and Indications

120 Coronary artery revascularization is an established therapeutic intervention and is therefore included in all treatment guidelines for patients with coronary artery disease. Although the procedure has been available for more than 40 years, constant technical progress in surgical and percutaneous revascularization continues to bring the benefits of revascularization therapy to new groups of patients. Therefore the indications and limitations of this approach need to be reviewed and updated periodically. The aim of revascularization therapy is to improve the prognosis or symptoms and quality of life in patients with ischemic heart disease. The revascularization process comprises two aspects: 1) indication and selection of the revascularization procedure, and 2) performance of the procedure. Involvement of the clinical cardiologist in the first step is fundamental. Basing their decisions on clinical, functional and anatomical features, these professionals detect and select patients who would benefit, and also help to select the revascularization technique. In this Update article on revascularization we review, for stable ischemic heart disease and non-ST segment elevation acute coronary syndromes, the following: 1) the most relevant aspects to consider when evaluating the need for and the type of revascularization (age, sex, diabetes, renal function, electrocardiographic changes, ventricular function, and quantification of functional relevance of coronary artery disease and viability of the acinetic areas); 2) indications for surgical or percutaneous intervention, and the choice of therapeutic strategy according to the latest clinical evidence and guidelines of scientific societies; and 3) currently available data on the controversy regarding choice of the revascularization procedure in patients with multivessel disease.