Mechanism and Management of Coronary Artery Disease

**3**

**Chapter 1**

Surgery

**Abstract**

Current Status, Perspectives, and

Future Directions of Multivessel

Disease and Left Main Coronary

Disease: Its Treatment by PCI or

MVD has evolved from an era where it was mandatory to treat all lesions, even very thin vessels. With the advent of more realistic anatomical scores such as the ERACI score and the gradient measurements with the fractional flow of reserve (FFR) and instantaneous wave-free ratio (iwFR), a more conservative era has begun, which benefits the patient in the long-term follow-up. The treatment of the LMCA remains a challenging lesion because of the amount of irrigation. It can be divided the treatment of the LMCA with a low or high ERACI score, in the first group is where the PCI has gained in confidence and dedication in addition to knowledge and bifurcation techniques. The second group with high score can only be performed in centers with high PCI experience, since their alternative will always be surgical as the first choice. The revascularization in MVD with STEMI, the priority is the culprit vessel and then evaluate the underlying lesions, an invasive or with a functional test in the short term. The patient with DM is a singular patient, and its treatment should always be evaluated by a multidisciplinary team. We believe that patients with low ERACI score have the possibility of being treated with

*Juan Mieres and Alfredo E. Rodríguez*

PCI, but patients with high score are surgical.

**1. Multivessel disease**

**1.1 Introduction**

**Keywords:** MVD, PCI, CABG, DM, MI, LMCA, MACCE, BMS, DES

The revascularization of multivessel disease (MVD) has advanced considerably and has gone through periods where angioplasty with the advent of conventional stents (BMS) was competitive with surgery [1]. After the incorporation of drugeluting stents (DES) with the significant reduction of the revascularization of the treated vessel, it was thought that the percutaneous coronary intervention (PCI) would be superior to coronary artery bypass graph (CABG), with the advent of the SYNTAX trial [2], which also incorporated an anatomical score that revolutionized the way of stratifying the patients. Although this trial used stents that are not
