BMJ  2005;330:785-786 (2 April), doi:10.1136/bmj.330.7494.785

Education and debate

Current controversies

Surgery is the best intervention for severe coronary artery disease

David P Taggart, professor of cardiovascular surgery, University of Oxford1

1 John Radcliffe Hospital, Oxford OX3 9DU david.taggart@orh.nhs.uk

A multidisciplinary approach is essential, but best evidence favours surgery over percutaneous intervention

The first 150 words of the full text of this article appear below.

Introduction

For the past two decades coronary artery bypass grafting has been the standard treatment for patients with severe multivessel ischaemic heart disease.1 In the past few years, however, it has been increasingly challenged by percutaneous coronary intervention. Indeed, in many parts of the developed world percutaneous coronary intervention is done twice as often as coronary artery bypass grafting. Why has this change in practice occurred? I believe that it is not evidence based, does not represent best value for money, and that patients are not appropriately informed of its limitations.

Research evidence

Coronary artery bypass grafting is probably the most intensively studied surgical procedure, with follow up data extending over 20 years.2 It is highly effective in relieving the symptoms of ischaemic heart disease and improving life expectancy in patients with certain anatomical patterns of disease; these benefits are magnified in patients with more severe disease and with impaired left ventricular function.1 . . . [Full text of this article]

Applicability of research

Safety of non-surgical treatment

Informing patients


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Rapid Responses:

Read all Rapid Responses

KETTLE CALLING THE POT BLACK.
BM Hegde
bmj.com, 2 Apr 2005 [Full text]
Shouldn't we see both sides of the argument
Mark Signy
bmj.com, 4 Apr 2005 [Full text]
Bypass Surgery versus Medical Therapy
Adam P Fitzpatrick
bmj.com, 5 Apr 2005 [Full text]
Hybrid or Hybris?
Aristotle D Protopapas FRCS
bmj.com, 5 Apr 2005 [Full text]
Endothelial Dysfunction as target for treatment in multivessel Coronary Artery Disease
MOHAMED S. NOSHI
bmj.com, 6 Apr 2005 [Full text]
surgery vs pci in multivessel disease.
manan vasenwala
bmj.com, 7 Apr 2005 [Full text]
Decision Theories to support the argument
David John O'Regan
bmj.com, 7 Apr 2005 [Full text]
Good article
Avinash Manohar Alva
bmj.com, 8 Apr 2005 [Full text]
A role for coronary artery disease specialists.
Lindsay C.H. John
bmj.com, 12 Apr 2005 [Full text]
CABG and PCI for severe coronary disease; complimentary not in competition
Michael S Norell, et al.
bmj.com, 15 Apr 2005 [Full text]
The Population Impact Of Both Cardiac Surgery And Angioplasty Is Surprisingly Small
Simon Capewell, et al.
bmj.com, 22 Apr 2005 [Full text]
The diminishing gap between stents and surgery
Christopher J Smith, et al.
bmj.com, 26 Apr 2005 [Full text]
Questionable Treatment of Coronary heart disease
Mike Holdem
bmj.com, 28 Mar 2007 [Full text]
Re: Endothelial Dysfunction as target for treatment in multivessel Coronary Artery Disease
Mohamed Noshi,MD,FACP, et al.
bmj.com, 28 Apr 2007 [Full text]
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