Tannas Jatene et al. Fabrício Ribeiro Las Casas Rogerio Lobo de Andrade Las Casas Vinicius Daher Vaz Alberto de Almeida Las Casas
According to most recent international guidelines on myocardial revascularization, fractional flow reserve (FFR)-guided percutaneous coronary intervention should be considered in patients with multivessel disease. That would include evaluation of all lesions between 40 to 90% diameter stenosis before implanting a stent., The same guidelines suggest prioritizing completeness of revascularization when the decision is made for coronary artery bypass graft surgery (CABG), which means bypassing all lesions >50% diameter stenosis.
In this issue of Arquivos Brasileiros de Cardiologia, Martins et al., approached this paradox with a meta-analysis of five studies and 1,114 patients, comparing physiology-guided CABG and conventional angiography-guided CABG. Although the pooled meta-analysis showed no difference in myocardial infarction and target vessel revascularization rates, a 37% relative risk reduction in all-cause death was associated with physiology-guided CABG.
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