Multivessel Disease

Excerpt

A coronary artery is a well-developed trilaminar structure. The innermost layer is termed the tunica intima, which is lined with endothelial cells that make contact with the circulating arterial blood. The endothelial cells have a tightly regulated vascular homeostasis mechanism, failure of which leads to atherosclerotic disease process. Multivessel disease is defined as significant stenosis (>70%) in two or more major coronary arteries of 2.5 mm diameter or more. About 40% to 50% of patients presenting with ST-elevation myocardial infarction (STEMI) have multivessel coronary disease.

Coronary artery bypass grafting (CABG) has been primarily used for revascularization of complex coronary artery disease (CAD) since 1968. When percutaneous intervention (PCI) was introduced in 1977, it was initially considered a treatment option for patients with single-vessel disease. Advancements in cardiothoracic surgical techniques with the utilization of smaller incisions, arterial conduits, off-pump CABG, and improved postoperative care have led to a reduction in morbidity and mortality and is the preferred revascularization method for multivessel disease. Recent technological and technical advancement in PCI techniques has broadened the treatment scope to now include patients with multivessel disease. Regardless of which modality is chosen, an interprofessional approach should be undertaken and account for various factors, including patient preference, surgical risk, and operator skill.