Background

Multivessel coronary artery disease (MVD) affects approximately 40–60% of patients undergoing coronary angiography and remains a major contributor to cardiovascular morbidity and mortality worldwide. The optimal revascularization strategy—whether percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or hybrid coronary revascularization (HCR)—continues to evolve with advancements in technology, imaging, and evidence-based practice.

Objective

To evaluate contemporary revascularization strategies in multivessel coronary disease, comparing clinical outcomes, procedural characteristics, and long-term prognosis associated with PCI, CABG, and hybrid approaches.

Methods

A multicenter comparative study involving 720 patients with angiographically confirmed multivessel coronary artery disease was conducted. Patients underwent PCI (n=320), CABG (n=280), or HCR (n=120). Procedural outcomes, in-hospital events, and 24-month major adverse cardiovascular and cerebrovascular events (MACCE) were analyzed.

Results

CABG demonstrated the lowest rate of repeat revascularization (6.4%), while PCI showed shorter hospital stays and lower procedural morbidity. Hybrid revascularization provided favorable outcomes with reduced invasiveness and comparable survival. Twenty-four-month MACCE rates were 18.1% for PCI, 12.5% for CABG, and 13.3% for HCR.

Conclusion

CABG remains the preferred strategy for complex multivessel disease, particularly among diabetic patients and those with high anatomical complexity. PCI offers excellent outcomes in selected patients with less complex disease. Hybrid revascularization represents a promising alternative combining the benefits of surgical durability and minimally invasive intervention.