| PCI |
Treatment of choice in coronary one- and two-vessel disease (e17) Second-choice treatment in left main stenosis and coronary three-vessel disease (only if surgical revascularization is contraindicated or the patient refuses surgery after detailed explanation)
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Good to very good control of symptoms Satisfactory long-term results Low invasiveness Anesthesia not required Low hospital mortality and morbidity Short hospital stay Short convalescence period
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No proof of a survival advantage compared with medical conservative treatment in randomized controlled studies Exposure to contrast medium Complete revascularization achieved less often than with ACB Hemorrhage, aneurysm, arteriovenous fistula Acute stent thrombosis
After PCI:
Intensive inhibition of thrombocyte aggregation necessary Increased occurrence of angina pectoris compared with ACB, necessitating re-intervention Re-stenosis rate of 20% to 30% with bare metal stent (BMS) Re-stenosis rate of 5% to 10% with drug-eluting stent
After implantation of a drug-eluting stent:
Prolonged treatment with aspirin+clopidogrel (at least 6 months vs. 4 weeks with BMS) (e17) Increased perioperative risk for surgery (cardiac/noncardiac) with dual platelet inhibition Increased risk of late stent thrombosis (compared with BMS)
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| ACB |
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Very good control of symptoms Good long-term results Proven survival advantage in patients with multi-vessel disease and restricted pump function, as well as left main stenosis Aspirin suffices for inhibition of thrombocyte aggregation Complete revascularization is usually achieved
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Compared with PCI:
More invasive Requires anesthesia Higher hospital mortality in patients with multimorbidity and/or advanced age Longer hospital stay Longer convalescence period Higher periprocedural morbidity
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