Therapeutic options in coronary artery disease: focusing on the guidelines.

There are three options for the treatment of patients with coronary artery disease: coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI) and optimal medical treatment alone. While there has been an active interface between CABG and PCI, medical treatment has not been as vociferously advocated. However, it performs well in randomized trials and is still a treatment arm in studies such as the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. The present review compares these options in acute and chronic coronary syndromes, including the indications for each as summarized by recent American College of Cardiology and American Heart Association guidelines. While the landscape in Canada is changing for CABG and PCI, with an increase in the latter procedure for patients with multivessel disease, optimal medical treatment alone is very effective. There are few subsets, particularly in chronic syndromes, in which revascularization is indicated for prognosis alone.