Percutaneous Coronary Revascularization JACC Historical Breakthroughs in Perspective

Over the last 4 decades, percutaneous coronary intervention has evolved dramatically and is now an acceptable treat-ment option for patients with advanced coronary artery disease. However, trialists have struggled to establish the respective roles for percutaneous coronary intervention and coronary artery bypass graft surgery, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease. Several pivotal trials and meta-analyses comparing these 2 revascularization strategies have enabled the relative merits of each technique to be established with regard to the type of ischemic syndrome, the coronary anatomy, and the patient's overall comorbidity. Precision medicine with individualized prognosis is emerging as an important method of selecting treatment. However, the never-ending advancement of technology, in conjunction with the emergence of novel pharmacological agents, will in the future continue to force us to reconsider the evolving question: Which treatment strategy is better and for which patient? (J Am Coll Cardiol 2021;78:384-407) (c) 2021 by the American College of Cardiology Foundation.

Automated summary

Over the past 40 years, percutaneous coronary intervention has become a standard treatment option for patients with advanced coronary artery disease. However, the roles of percutaneous coronary intervention and coronary artery bypass graft surgery in different patient populations continue to be debated, with personalized medicine emerging as an important consideration. Advancements in technology and pharmaceuticals will continue to shape the conversation around the best treatment strategies for individual patients.