Coronary artery bypass grafting and percutaneous coronary intervention in coronary artery disease: evidence and guidance

Coronary artery disease (CAD) remains a leading cause of acute myocardial infarction, heart failure, and premature mortality despite advances in prevention and pharmacologic therapy. Revascularization is fundamental for subjects with anatomically significant CAD, particularly those with refractory symptoms or a high risk of adverse outcomes, and it relies on two principal strategies: coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Within this context, this narrative review aims to clarify how current scientific evidence and the most recent clinical practice guidelines inform the choice between these therapeutic options in clinical settings. To that end, the review examines the pathophysiologic foundations of CAD, its major risk factors, and the indications for revascularization. It then synthesizes key comparative considerations between CABG and PCI, including prevention of cardiovascular events, recovery trajectories, and the likelihood of achieving complete revascularization. Clinical modifiers that influence decision making are analyzed, such as diabetes, patient age, and the anatomical complexity of coronary lesions. In addition, the review outlines technological advances that characterize modern PCI and summarizes fundamental principles for graft selection in CABG. The overall goal is to provide a practical reference framework, centered on multidisciplinary teamwork and shared decision making, that enables optimization of the revascularization strategy in alignment with individual clinical objectives and patient preferences.