The impact of surgical and percutaneous coronary revascularization on the cardiac myocyte.

Re-establishing coronary blood flow to a segment of myocardium suffering from cessation or diminution of flow, either with surgical or percutaneous approaches, may be complicated by injury to the myocardium. During surgical revascularization with coronary artery bypass grafting (CABG), aortic cross-clamping and subsequent reduction in oxygen transport to the myocardium may result in cardiac myocyte injury and myonecrosis. This injury can be compounded if protection of the myocardium using myocardial protective strategies is not adequate. Ischemia/reperfusion cellular alterations may contribute to this injury as well. Percutaneous coronary interventions (PCI) are also associated with myonecrosis resulting from side branch compromise, distal embolization of debris, and plugging of the microcirculation, as well as ischemia/reperfusion injury. Intracoronary filtering devices have not been shown to improve outcomes associated with such complications. Which revascularization strategy is associated with superior outcomes and less cardiac myocyte necrosis is an area of continuing controversy.