Percutaneous coronary intervention in the 1990s. Results in patients with single or multivessel disease.

The proper role of percutaneous coronary intervention in the 1990s relative to other forms of therapy remains to be defined and appears to be a continually moving target. Ongoing randomized comparative studies with bypass surgery in patients with complex disease will assist in defining the role of angioplasty and bypass surgery, but should be viewed carefully with regard to the apparent improvements in procedural outcome and demonstrated effective patient heterogeneity on outcome. It is likely that percutaneous revascularization will remain the mainstay of therapy for patients with single vessel coronary disease who have lifestyle limiting angina or can be demonstrated to have large areas of ischemia with little provocation. One exception to this generalization might be for patients with ostial or very proximal left anterior descending narrowings in whom bypass surgery might be a better long-term therapy. Unfortunately, little truly comparable data exists for patients treated with percutaneous revascularization and bypass surgery within this group. Percutaneous revascularization will also probably remain the preferred therapy for patients with relatively focal multivessel coronary disease whilst bypass surgery will remain the preferred approach for patients with more diffuse disease and possibly for those with moderate or moderate to severe left ventricular contractile impairment. It might be expected, however, that improvements in procedural outcome with percutaneous revascularization will allow interventionalists to gradually encroach upon the previous domain of cardiac surgeons.