Coronary artery disease is narrowing or blockage of the coronary arteries caused mainly by atherosclerosis. Treatment is not automatically a stent or bypass operation. Current European guidance starts with diagnosis, lifestyle and risk-factor treatment, symptom control and event-prevention medication, then uses revascularization when clinically indicated. When revascularization is needed, PCI and CABG should be compared according to coronary anatomy, ventricular function, diabetes and other comorbidities, procedural risk and the patient's goals.
Confirm the coronary diagnosis and risk before choosing revascularization
The 2024 ESC chronic-coronary-syndrome pathway combines clinical likelihood, non-invasive imaging and invasive assessment where appropriate. Not every chest-pain patient has obstructive coronary disease, and not every stenosis requires immediate intervention.
- Symptoms and cardiovascular risk factors
- ECG, echocardiography and laboratory assessment
- Coronary CT angiography or functional imaging when appropriate
- Invasive coronary angiography when indicated
- Functional assessment of intermediate stenoses when relevant
- Left-ventricular function and associated valve disease
Medical treatment remains a core part of care
Lifestyle and risk-factor modification together with disease-modifying and antianginal medication remain fundamental even when PCI or CABG is performed. A revascularization procedure does not replace long-term management of atherosclerotic cardiovascular risk.
PCI / stenting can be the appropriate revascularization route
PCI uses a catheter to dilate a coronary narrowing and usually place a stent. It can be appropriate for many coronary anatomies and is central in acute coronary syndromes, but the benefit and durability of PCI must be interpreted in the context of disease complexity and the patient's overall risk profile.
CABG can be preferred in selected complex disease
Bypass surgery creates new routes around narrowed coronary arteries. Current European guidance supports CABG over PCI in important selected scenarios, including some complex multivessel or left-main disease and certain patients with diabetes or impaired ventricular function when anatomy and surgical risk support surgery.
Records for an international coronary review
Send enough information for the center to compare medical, interventional and surgical options rather than asking only for a stent or bypass quotation.
- Coronary CT or angiography images and reports
- Prior PCI/stent or bypass operative reports
- Echocardiography and ventricular-function data
- Stress imaging or functional testing if performed
- Recent laboratory results including kidney function
- Current medications, diabetes status and major comorbidities
- Description of angina, breathlessness and exercise limitation
Sources and review
This guide was last source-reviewed on 2026-08-31.