Comparison of CABG and PTCA (CABG – coronary artery bypass grafting, also known as coronary artery bypass grafting; PTCA – percutaneous transluminal coronary angioplasty) CABG is one of the major inventions in the history of human medicine in the twentieth century, and after more than 30 years of clinical practice, CABG has evolved and become one of the most common and effective methods for the treatment of CAD. In 1977, Gruentzing performed the first successful PTCA case. This ushered in a new era of interventional cardiology. In 1987, Sigwart was the first to use intracoronary stenting in clinical practice. With the accumulation of experience, improvement of instruments and techniques, the indications for PTCA were expanded and complications were gradually reduced. The development of interventional techniques ended the history that only cardiac surgeons could perform revascularization, posing a great challenge to CABG. The advantages of PCI are ease of application, avoidance of general anesthesia, open chest, extracorporeal circulation, less patient pain, CNS complications and shorter time to return to health.PCI is increasingly used because it is easier to perform than repeat CABG and can achieve revascularization more rapidly in emergency situations.The disadvantages of PCI are earlier restenosis, inability to resolve multiple completely occluded Restenosis rates as high as 30-50% within 6 months after PTCA are an important problem for interventional therapy and are one of the focal points of interventional cardiology research. Stenting has been effective in reducing restenosis rates to about 20%-30%, and in recent years, the use of drug-coated stents is expected to further significantly reduce restenosis rates. The advantage of CABG is its greater durability and more complete completion of complete revascularization, independent of the morphology of the atherosclerotic lesion in its obstructing vessel. In general, the more diffuse the coronary lesion, the more CABG should be selected, especially when LV insufficiency is present. Many CABG studies fail to reflect the results of current surgical practice. Currently, arterial bypass grafts are mostly used whenever technically feasible for the surgeon, and the 10-year patency rate of the grafted vessel lumen is over 90%. Nonstop bypass procedures are also used in selected patients, resulting in fewer complications. The correct and rational selection of PCI and CABG is a difficult issue, since the treatment is not performed by the same specialized physicians. Both physicians and surgeons think first of the treatment they are familiar with. To date there are no clinical trials that clearly demonstrate that one treatment is clearly superior to the other. No one treatment is perfect, completely curative and applicable to all patients. There have been many randomized and non-randomized studies comparing CABG and PTCA. Despite some limitations of these studies, some general conclusions have been obtained from comparative trials of CABG and PTCA. In patients with single-branch lesions: PTCA versus CABG long-term survival is similar to the incidence of myocardial infarction. However, patients who underwent PTCA required more anti-AP medication and significantly more target revascularization (TVR) than CABG patients, mainly due to restenosis after PTCA. According to the RITA (Randomized Comparison of Angina Interventions) study, the rate of death was the same in the single lesion PTCA group (3.8%) as in the CABG group at 4-7 years of follow-up, and the incidence of MI was slightly higher in the CABG group (10.8%) than in the PTCA group (5.1%), but those requiring target lesion revascularization were significantly higher in the PTCA group (40.5%) than in the CABG group (9.1%). However, the incidence of AP at 3 years was similar in both groups (17.5% and 16.1%, respectively). In patients with multiple lesions: follow-up studies of multiple PTCA and CABG randomized clinical trials with multiple lesions conducted between 1993 and 1997 showed that although patients in the PTCA group returned to work 5 weeks earlier than those in the CABG group, functional status, including daily activities, improved less in the PTCA group than in the CABG group, and overall mortality, cardiac There was no difference in the incidence of total mortality, cardiac mortality and MI between the two groups. Patients in the CABG group had a higher rate of AP-free episodes and required less revascularization compared to the PTCA group. Results from the BARI trial showed that the 5-year survival rate was higher in the CABG group than in the PTCA group in patients with multiple DM lesions. According to the PITA, ERACI, CABRI, EAST, and BARI randomized controlled studies of PTCA versus CABG, in patients with multiple lesions with no previous history of PTCA or CABG, good left heart function, no LM lesions and recent MI, and lesions suitable for both CABG and PTCA, PTCA versus CABG had immediate and long-term (1 -However, the mortality rate in the PTCA group was higher than that in the CABG group for combined DM; more patients in the PTCA group had recurrent AP and required repeat revascularization (3-10 times more than in the CABG group), and 20% of patients required CABG within the first 1-3 years; the incidence of MI during hospitalization was higher in the CABG group than in the PTCA group. The incidence of MI during hospitalization was higher in the CABG group than in the PTCA group, and the hospitalization period was longer and recovery was slower. The cost of one PTCA was lower than that of CABG in Western countries, but the cost spent in 1 year was similar in both groups due to the results of repeated PTCA. In China, the cost of CABG is lower than that of PCI. The ARTS trial was the first clinical trial comparing stenting with CABG in patients with multiple lesions. After 1-year follow-up, its results showed that the incidence of death, stroke, and MI was similar in the coronary stenting and CABG groups, and revascularization was performed more often in the stenting group than in the CABG group, and its causes were still related to restenosis after PCI. At 2-year follow-up in patients with DM, mortality and significant adverse cardiac events were lower in the CABG group than in the stenting group. In patients with multiple lesions combined with left heart insufficiency, the in-hospital morbidity and mortality rates were similar between PTCA and CABG, and the incidence of peri-procedural stroke was higher in the CABG group than in the PTCA group. However, further analysis showed that the long-term outcome was influenced more by the completeness of revascularization than by the method of revascularization. It has been shown that in patients with complete revascularization, the incidence of cardiac events was similar in PTCA and CABG-free. In patients with multiple lesions combined with left heart insufficiency, especially in combination with DM, CABG therapy should be recommended if complete revascularization cannot be achieved with PTCA. Therefore, CABG is a more beneficial option for patients with DM, diffuse lesions in multiple vessels, LV hypoplasia, LM end, and multiple lesions with LAD opening lesions and in patients in whom complete revascularization cannot be achieved by PCI. In conclusion, during the treatment of CAD, the choice of treatment plan should be based on the results of coronary angiography, the evaluation of LV function, the patient’s symptoms and the extent of myocardial ischemia. The more accepted views are as follows: PCI is appropriate for: single/dual-branch lesions with moderate or more extensive myocardial ischemia or evidence of surviving myocardium, with LAD involvement, capable of complete revascularization; lesions with a high success rate of PCI, low surgical risk, and low restenosis rate (e.g., short lesions with vessel diameter >2.5 mm); multi-branch lesions capable of complete revascularization; those with contraindications to surgical procedures , or who are to undergo non-cardiac major surgical procedures; patients with ACS, especially AMI. CABG is indicated in patients with multibranch lesions with LVEF <40% and in whom PCI cannot perform complete revascularization; LM lesions and LAD opening lesions with multibranch lesions; lesions inaccessible to interventional devices, such as severe curvature, calcification, and chronic complete occlusion; DM with diffuse multibranch lesions that cannot be stented; lesions with alternating stenosis and aneurysmal dilatation; and patients without anterior MI LAD occlusion with unsuccessful PCI. In addition, the choice of treatment modality for coronary artery disease should be made in consultation with the patient in addition to the above considerations. Each person has his or her own different lifestyle, and the patient's own opinion should be sought in cases where both PCI and CABG are indicated, which often plays a decisive role. If the patient wishes to have less pain, recover sooner and return to work sooner, and is willing to accept a higher restenosis rate than CABG, he or she may choose PCI treatment. If the patient wants to be free of angina for a longer period of time after the procedure, CABG should be chosen.