Controversias en la revascularización y el estudio de viabilidad miocárdica en el síndrome coronario crónico

Abstract

The broad spectrum of patients with chronic coronary syndrome and the controversies in diagnosis and treatment pose a major challenge in clinical decision making. Concerning the diagnosis, the utility of myocardial viability study has been questioned by recent clinical trials. Regarding the therapeutic approach, in patients with simple coronary disease, percutaneous revascularization has proved its utility in anginal symptoms relieve, but the evidence regarding a prognostic benefit is contradictory. In complex coronary disease, coronary artery bypass grafting surgery has reported better results than percutaneous intervention. Besides, surgical revascularization has demonstrated a reduction in cardiovascular events over medical treatment in patients with ischemic left ventricular dysfunction. In this review we critically analyse the current evidence on viability study and myocardial revascularization in patients with chronic coronary syndrome.