Angioplasty or surgery in multivessel disease.

The aims of myocardial revascularisation are to treat angina, reduce ischae mia and improve life expectancy. Patients with multivessel disease have a p oor prognosis, especially when the lesions are proximal, when the preseptal left anterior descending artery is involved and when left ventricular dysf unction is present. In this particular group of patients, coronary bypass surgery has been show n to improve 10 year survival. Coronary angioplasty has been compared with surgical treatment in many clinical trials. The medium-term survival is the same in both groups, but with a higher number of repeat procedures except in diabetic patients in whom mortality is higher after angioplasty. The use of coronary stents should reduce the number of post-angioplasty procedures . Constant technical improvements, the introduction of surgery without cardio pulmonary bypass, combined revascularisation procedures, new antiplatelet d rugs, the absence of long-term comparative results, all this results in a p ersonalised choice of revascularisation procedure based on the overall clin ical and angiographie features of each particular case.