[Myocardial revascularization: surgery or angioplasty?].

The approach to patients suffering from angina pectoris or silent ischaemia has changed considerably over recent years, as progress in surgery and percutaneous techniques now allows the treatment of almost every situation, at least anatomically, and the various treatment techniques must be evaluated in order to provide the best treatment for each patient. On the basis of the data currently available in the literature, there is increasing evidence to suggest that percutaneous or surgical revascularization constitutes an advantage for symptomatic patients or patients with silent ischaemia, compared to medical treatment. The best strategy for each patient must then be defined. Patients with 2- or 3-vessel disease with involvement of the proximal LAD artery should be treated by surgical revascularization. Angioplasty appears to be preferable in all other situations. Antiaggregant treatment must obviously be associated with these revascularization procedures and must be prescribed in the long-term. Medical anti-ischaemic treatment is complementary, especially when some territories cannot be revascularized. This article reviews the current situation.