[Angioplasty or bypass for multitruncal coronary disease. Viewpoint of the cardiologist].

When multivessel coronary disease requires revascularization, a choice must be made between percutaneous angioplasty and bypass surgery. Angioplasty is considerably less invasive and does not require a prolonged hospital stay. Nevertheless, it is less effective for longstanding coronary occlusions and is limited by a restenosis rate of 20 to 40% which often means a new intervention. At the present time, surgery remains the standard mode of therapy in a large proportion of patients with multivessel disease. However, the procedure is more complex than the percutaneous approach and long-term venous graft attrition remains an unresolved issue. Surgery and angioplasty have been compared in several randomized and prospective studies which are reviewed here. The results of these comparisons, while useful for current clinical decision-making, will require reassessment in the future to take into account the predictable improvements in safety, efficacy and long-term results of percutaneous techniques.