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European Heart Journal Advance Access published online on April 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi249
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European Heart Journal © The European Society of Cardiology 2005; all rights reservedq
Received November 19, 2004
Revised February 22, 2005
Accepted March 3, 2005

Review

Complete myocardial revascularization: between myth and reality

Marco Zimarino 1*, Antonio Maria Calafiore 2, and Raffaele De Caterina 1

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

* To whom correspondence should be addressed.
Marco Zimarino, E-mail: m.zimarino{at}unich.it


  Abstract

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.

Keywords: Revascularization; Coronary artery bypass surgery; Angioplasty; Stents.
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