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European Heart Journal Advance Access originally published online on April 11, 2005
European Heart Journal 2005 26(18):1824-1830; doi:10.1093/eurheartj/ehi249
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Complete myocardial revascularization: between myth and reality

Marco Zimarino1,*, Antonio Maria Calafiore2 and Raffaele De Caterina1

1Institute of Cardiology and Centre of Excellence on Aging, ‘G. d'Annunzio’ University, Ospedale S. Camillo de Lellis, Via Forlanini, 50, 66100 Chieti, Italy
2Department of Cardiac Surgery, University of Turin, Italy

Received 19 November 2004; revised 22 February 2005; accepted 3 March 2005; online publish-ahead-of-print 11 April 2005.

* Corresponding author. Tel: +39 0871 41512; fax: +39 0871 402817. E-mail address: m.zimarino{at}unich.it

Myocardial revascularization in patients with multi-vessel coronary artery disease may be accomplished, by percutaneous interventions or surgery, either on all diseased lesions or directed to selectively targeted coronary segments. The extent of planned revascularization is often a major determinant of treatment strategy. Revascularization of all diseased coronary segments—complete myocardial revascularization—has a potential long-term benefit, but is more complex and may increase in-hospital untoward events. Revascularization may otherwise be incomplete, either because of the operator's inability to treat all diseased coronary segments or by choice of deciding to selectively revascularize only large areas of myocardium at risk. Although incomplete revascularization may negatively affect long-term outcomes, it may be, when wisely chosen, the preferred treatment strategy in selected patient categories because of its lower immediate risks. The patient's clinical status, ventricular function, and the presence of co-morbidities may orient clinical decisions in favour of incomplete revascularization.

Key Words: Revascularization • Coronary artery bypass surgery • Angioplasty • Stents


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