Korean J Med.  2014 Dec;87(6):675-685. 10.3904/kjm.2014.87.6.675.

Ischemia-guided Revascularization for Stable Ischemic Heart Disease

• Kim YH

• KMID: 2269362
• DOI: http://doi.org/10.3904/kjm.2014.87.6.675

Abstract

Current evidence and guidelines support the strategy of ischemia-guided revascularization for treatment of patients with stable coronary symptoms. However, anatomical stenosis is often targeted in revascularization treatment using percutaneous coronary intervention or coronary artery bypass surgery without seriously considering objective evidence of myocardial ischemia. Angiographic complete revascularization was traditionally considered to be an ideal objective of revascularization treatment, particularly for patients with multivessel disease. However, recent observational studies have contradicted the concept of angiographic complete revascularization and have, instead, supported the benefits of ischemia-guided selective revascularization based on noninvasive and invasive functional evaluation for detection of ischemia-producing coronary lesions. No trials have been specifically designed to assess the relative benefits of either strategy. Therefore, the present review explores current concepts of the strengths and weaknesses of anatomical versus functional revascularization.

Keyword

Coronary artery disease; Stent; Bypass graft; Ischemia

MeSH Terms

Constriction, Pathologic
Coronary Artery Bypass
Coronary Artery Disease
Humans
Ischemia
Myocardial Ischemia*
Percutaneous Coronary Intervention
Stents