Comparative analysis of factors associated with the choice of percutaneous and surgical intervention in the treatment of coronary artery disease: An integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v15i2.50719

Keywords:

Percutaneous Coronary Intervention, Coronary Artery Bypass Grafting, Coronary Artery Disease.

Abstract

Coronary Artery Disease (CAD) is among the pathologies responsible for high mortality rates in Brazil, associated with a significant increase in cardiovascular risk factors. In this context, the purpose of this integrative literature review is to analyze and compare the factors influencing the appropriate choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in managing this cardiac condition, considering clinical and anatomical variables and the SYNTAX score. CAD presents a broad spectrum of clinical manifestations, and the therapeutic decision depends on individual patient characteristics, including lesion complexity, age, associated comorbidities, and ventricular function. CABG is the preferred clinical alternative for patients with diffuse disease and complex coronary anatomy, while PCI demonstrates better results in less severe lesions with faster recovery. Given the above, this research adopts an integrative literature review approach, seeking to consolidate evidence from the last five years to understand the criteria used in clinical practice and their implications for health outcomes. This comparative analysis aims to promote a more personalized management of CAD, assisting evidence-based therapeutic choices that optimize results for different patient profiles.

References

Banning, A. P., Serruys, P. W., De Maria, G. L., Ryan, N., Walsh, S., Gonzalo, N., Van Geuns, R. J., Onuma, Y., Sabaté, M., Davies, J., Lesiak, M., Moreno, R., Cruz-Gonzalez, I., Hoole, S. P., Piek, J. J., Escaned, J., Spitzer, E., Tijssen, J., … Piek, J. (2022). Five-year outcomes after state-of-the-art percutaneous coronary revascularization in patients with de novo three-vessel disease: Final results of the SYNTAX II study. European Heart Journal, 43(13), 1307–1316. https://doi.org/10.1093/eurheartj/ehab703

Bassan, F., Esporcatte, R., Correia, M. G., Guina, O. D., Weigert, G. S., & Oliveira, G. C. N. (2025). O efeito da cirurgia de revascularização do miocárdio na função contrátil e nos sintomas em pacientes com disfunção do ventrículo esquerdo. Arquivos Brasileiros de Cardiologia, 122(4), e20240486. https://doi.org/10.36660/abc.20240486

Bhatt, D. L., Eagle, K. A., Ohman, E. M., Hirsch, A. T., Goto, S., Mahoney, E. M., & Röther, J. (2010). Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA, 304(12), 1350–1357. https://doi.org/10.1001/jama.2010.1322

Carvalho, T., Milani, M., Ferraz, A. S., Sousa, C. A. C., Pimentel, M. D. L., & Figueiredo, L. C. (2020). Diretriz brasileira de reabilitação cardiovascular – 2020. Arquivos Brasileiros de Cardiologia, 114(5), 943–987. https://doi.org/10.36660/abc.20200407

Crossetti, M. G. O. (2012). Revisão integrativa de pesquisa na enfermagem o rigor cientifico que lhe é exigida. Rev Gaúcha Enferm. 33(2):8-9. https://doi.org/ 10.1590/S1983-14472012000200001

De Bruyne, B., Pijls, N. H. J., Kalesan, B., Barbato, E., Tonino, P. A. L., Piroth, Z., … Koolen, J. J. (2012). Fractional flow reserve–guided PCI versus medical therapy in stable coronary disease. The New England Journal of Medicine, 367(11), 991–1001. https://doi.org/10.1056/NEJMoa1205361

De Oliveira, G. M. M., Brant, L. C. C., Malta, D. C., & Kawachi, I. (2024). Cardiovascular statistics – Brazil 2023. Arquivos Brasileiros de Cardiologia, 121(2). https://doi.org/10.36660/abc.20240079

De Souza, M. T., Barbosa, A. H. P., & Caixeta, A. (2018). Intervenção percutânea e revascularização miocárdica no paciente com diabetes mellitus: Elementos que devem ser considerados. Revista da Sociedade de Cardiologia do Estado de São Paulo, 28(2), 176–180.

Farkouh, M. E., Domanski, M., Sleeper, L. A., Siami, F. S., Dangas, G., Mack, M., Yang, M., Cohen, D. J., Rosenberg, Y., Solomon, S. D., Desai, A. S., Gersh, B. J., Magnuson, E. A., Lansky, A. J., Boineau, R., Weinberger, J., Ramanathan, K., Sousa, J. E., Rankin, J., Bhargava, B., & Fuster, V. (2012). Strategies for multivessel revascularization in patients with diabetes. The New England Journal of Medicine, 367(25), 2375–2384. https://doi.org/10.1056/NEJMoa1211585

Feng, S., Li, Y., Zhang, Y., Xu, Y., & Wu, J. (2023). Ten-year outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for multivessel or left main coronary artery disease: A systematic review and meta-analysis. Journal of Cardiothoracic Surgery, 18(1), 54. https://doi.org/10.1186/s13019-023-02101-y

Feres, F., Costa, R. A., Abizaid, A., Hueb, W. A., et al. (2017). Diretriz da Sociedade Brasileira de Cardiologia e da Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista sobre intervenção coronária percutânea. Arquivos Brasileiros de Cardiologia, 109(Supl. 1), 1–81. https://doi.org/10.5935/abc.20170111

Gaba, P., Sabik, J. F., Murphy, S. A., Bellavia, A., O’Gara, P. T., Smith, P. K., Serruys, P. W., Kappetein, A. P., Park, S. J., Park, D. W., Christiansen, E. H., Holm, N. R., Nielsen, P. H., Sabatine, M. S., Stone, G. W., & Bergmark, B. A. (2024). Percutaneous coronary intervention versus coronary artery bypass grafting in patients with left main disease with and without diabetes: Findings from a pooled analysis of 4 randomized clinical trials. Circulation, 149(17), 1328–1338. https://doi.org/10.1161/CIRCULATIONAHA.123.065571

Gaudino, M., Andreotti, F., & Kimura, T. (2023). Current concepts in coronary artery revascularisation. The Lancet, 401(10388), 1611–1628. https://doi.org/10.1016/S0140-6736(23)00459-2

Harrison, T. R., Kasper, D. L., Fauci, A. S., Hauser, S. L., & Jameson, J. L. (Eds.). (2022). Medicina interna de Harrison (21ª ed.). AMGH.

Head, S. J., Milojevic, M., Daemen, J., Ahn, J. M., Boersma, E., Christiansen, E. H., … Kappetein, A. P. (2018). Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. The Lancet, 391(10124), 939–948. https://doi.org/10.1016/S0140-6736(18)30423-9

Iribarne, A., Chang, H., Alexander, J. H., & Smith, P. K. (2018). Comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention. The Journal of Thoracic and Cardiovascular Surgery, 156(4), 1410–1421.e2. https://doi.org/10.1016/j.jtcvs.2018.04.121

Kip, K. E., Faxon, D. P., Detre, K. M., Yeh, W., & Kelsey, S. F. (1996). Coronary angioplasty in diabetic patients. Circulation, 94(8), 1818–1825. https://doi.org/10.1161/01.CIR.94.8.1818

Krylov, V. (2020). Clinical case study: Combined surgical treatment of ischemic mitral regurgitation. Regional Blood Circulation and Microcirculation, 19(2), 24–31. https://doi.org/10.24884/1682-6655-2020-19-2-24-31

Kumar, P. N., Reddy, N. K., Naik, N., Rao, T. V., & Mani, K. (2022). Percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease. Indian Heart Journal, 74(1), 41–48. https://doi.org/10.1016/j.ihj.2021.12.014

Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F. L., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Nnacheta, L. C., … Wijeysundera, D. N. (2022). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization. Circulation, 145(3), e18–e114. https://doi.org/10.1161/CIR.0000000000001038

Llerena-Velastegui, J., Zumbana-Podaneva, K., Velastegui-Zurita, S., Mejia-Mora, M., Perez-Tomassetti, J., Cabrera-Cruz, A., … Sanahuja-Montiel, C. (2024). Comparative efficacy of percutaneous coronary intervention versus coronary artery bypass grafting in treatment of ischemic heart disease: Systematic review and meta-analysis of recent RCTs. Cardiology Research, 15(3), 153–168. https://doi.org/10.14740/cr1638

Marinho, F., Passos, V. M. A., França, E. B., Duncan, B. B., Ribeiro, A. L. P., Guimarães, R. M., Teixeira, R. A., Rocha, R., Schmidt, M. I., & Naghavi, M. (2018). Burden of disease in Brazil, 1990–2016: A systematic subnational analysis for the Global Burden of Disease Study 2016. The Lancet, 392(10149), 760–775. https://doi.org/10.1016/S0140-6736(18)31221-2

Nabel, E. G., & Braunwald, E. (2012). A tale of coronary artery disease and myocardial infarction. The New England Journal of Medicine, 366(1), 54–63. https://doi.org/10.1056/NEJMra1112570

National Heart, Lung, and Blood Institute. (2023). Angioplastia coronariana. https://www.nhlbi.nih.gov/health/stents/during

Neumann, F. J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J. P., Falk, V., Head, S. J., Jüni, P., Kastrati, A., Koller, A., Kristensen, S. D., Niebauer, J., Richter, D. J., Seferović, P. M., Sibbing, D., Stefanini, G. G., … Zembala, M. O. (2019). 2018 ESC/EACTS guidelines on myocardial revascularization. European Heart Journal, 40(2), 87–165. https://doi.org/10.1093/eurheartj/ehy394

Nicolau, J. C., Timerman, A., Marin-Neto, J. A., Piegas, L. S., Barbosa, C. J. D. G., Ferreira, J. F. M., Santos, E. S., Andrade, M. D., Mattos, L. A. P., Albuquerque, D. C., & Sociedade Brasileira de Cardiologia. (2021). Diretrizes da Sociedade Brasileira de Cardiologia sobre angina instável e infarto agudo do miocárdio sem supradesnível do segmento ST – 2021. Arquivos Brasileiros de Cardiologia, 117(1), 181–264. https://doi.org/10.36660/abc.20210180

Oliveira, G. M. M. , Brant, L. C. C., Polanczyk, C. A., Malta, D. C., Biolo, A., Nascimento, B. R., Souza, M. F. M. , Lorenzo, A. R. D., Fagundes Júnior, A. A. P., Schaan, B. D., Castilho, F. M. , Cesena, F. H. Y., Soares, G. P., Xavier Junior, G. F., Barreto Filho, J. A. S., Passaglia, L. G., Pinto Filho, M. M., Machline-Carrion, M. J., Bittencourt, M. S., Pontes Neto, O. M., Villela, P. B., Teixeira, R. A., Sampaio, R. O., Gaziano, T. A., Perel, P., Roth, G. A., & Ribeiro, A. L. P. (2022). Estatística Cardiovascular – Brasil 2021. Arq. Bras. Cardiol., 118(1), 115-373. https://doi.org/10.36660/abc.20211012

Park, S., Park, S. J., & Park, D. W. (2023). Percutaneous coronary intervention versus coronary artery bypass grafting for revascularization of left main coronary artery disease. Korean Circulation Journal, 53(3), 113–133. https://doi.org/10.4070/kcj.2022.0333

Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria: Editora da UFSM.

Précoma, D. B., Oliveira, G. M. M., Simão, A. F., Dutra, O. P., Coelho, O. R., Izar, M. C. O., Póvoa, R. M. S., & Sociedade Brasileira de Cardiologia. (2019). Updated cardiovascular prevention guideline of the Brazilian Society of Cardiology – 2019. Arquivos Brasileiros de Cardiologia, 113(4), 787–891. https://doi.org/10.5935/abc.20190204

Risemberg, R. I. C. et al. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica, 7(1), e0171675. https://doi.org/10.52076/eacad-v7i1.675

Serruys, P. W., Morice, M. C., Kappetein, A. P., Colombo, A., Holmes, D. R., Mack, M. J., Ståhle, E., Feldman, T. E., van den Brand, M., Bass, E. J., Van Dyck, N., Leadley, K., Dawkins, K. D., & Mohr, F. W. (2009). Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. The New England Journal of Medicine, 360(10), 961–972. https://doi.org/10.1056/NEJMoa0804626

Stone, G. W., Kappetein, A. P., Sabik, J. F., Pocock, S. J., Morice, M.-C., Puskas, J. D., Kandzari, D. E., … Serruys, P. W. (2019). Five-year outcomes after PCI or CABG for left main coronary disease. The New England Journal of Medicine, 381(19), 1820–1830. https://doi.org/10.1056/NEJMoa1909406

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, Elsevier. 104(C), 333-9. https://doi.org/10.1016/j.jbusres.2019.07.039

SYNTAX Score Working Group. (2013). SYNTAX score II calculator. https://syntaxscore.org/calculator/syntaxscore/framesetss2.htm

Taggart, D. (2018). Cirurgia de revascularização do miocárdio. Annals of Cardiothoracic Surgery. https://www.annalscts.com/article/view/16534/16789

Xie, Q., Huang, J., Zhu, K., & Chen, Q. (2021). Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta-analysis. Clinical Cardiology, 44(9), 899–906. https://doi.org/10.1002/clc.23613

Yoon, Y. H., Ahn, J. M., Kang, S. J., Lee, J. Y., Song, H., Lee, P. H., Park, D. W., Kim, Y. H., Lee, S. W., Kim, W. J., Yun, S. C., Lee, C. W., Park, S. W., & Park, S. J. (2020). Impact of SYNTAX score on 10-year outcomes after revascularization for left main coronary artery disease. JACC: Cardiovascular Interventions, 13(22), 2680–2690. https://doi.org/10.1016/j.jcin.2019.10.020

Young, M. N., Kolte, D., Cadigan, M. E., Laikhter, E., Sinclair, K., Pomerantsev, E., Fifer, M. A., Sundt, T. M., Yeh, R. W., & Jaffer, F. A. (2020). Multidisciplinary heart team approach for complex coronary artery disease: Single center clinical presentation. Journal of the American Heart Association, 9(8), e014738. https://doi.org/10.1161/JAHA.119.014738

Downloads

Published

2026-02-28

Issue

Section

Health Sciences

How to Cite

Comparative analysis of factors associated with the choice of percutaneous and surgical intervention in the treatment of coronary artery disease: An integrative review. Research, Society and Development, [S. l.], v. 15, n. 2, p. e8015250719, 2026. DOI: 10.33448/rsd-v15i2.50719. Disponível em: https://www.rsdjournal.org/rsd/article/view/50719. Acesso em: 1 mar. 2026.