Introduction: Ischemic heart diseases are the major leading cause of death worldwide.
Revascularization procedures dramatically reduced the overall risk for death related to acute coronary
syndromes. Two kinds of myocardial revascularization can grossly be outlined: percutaneous
coronary intervention (PCI) and surgical coronary artery bypass graft intervention (CABG).
The net clinical benefit coming from these two kinds of procedures is still under debate.
Methods: We have traced the state-of-the-art background about myocardial revascularization procedures
by comparing the most important trials dealing with the evaluation of percutaneous interventions
versus a surgical approach to coronary artery diseases.
Results: Both PCI and CABG have become effective treatments for revascularization of patients suffering
from advanced CAD. The advance in technology and procedural techniques made PCI an attractive
and, to some extent, more reliable procedure in the context of CAD. However, there are still
patients that cannot undergo PCI and have to be rather directed towards CABG.
Conclusion: CABG still remains the best strategy for the treatment of multiple vessel CAD due to
improved results in term of survival and freedom from reintervention. Anyway, a systematic, multidisciplinary
approach to revascularization is the fundamental behaviour to be chased in order to effectively
help the patients in overcoming its diseases. The creation of the “heart team” seems to be a
good option for the correct treatment of patients suffering from stable and unstable CAD.