BMJ  2007;334:593-594 (24 March), doi:10.1136/bmj.39154.552280.BE

Editorials

Coronary revascularisation

Surgery is effective on clinical and economic grounds, but stenting does not seem to be cost effective

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

This week, the BMJ publishes three studies dealing with revascularisation in ischaemic heart disease.^{1 2 3} Two of the studies compare the clinical effectiveness¹ and cost effectiveness² of revascularisation of isolated left anterior descending coronary disease by stenting or surgery, while the third examines the cost effectiveness of medical treatment, stenting, and surgery in multivessel disease.³ The studies raise key issues not only about the decision making process for intervention in the individual patient but also how to obtain maximum value from limited health service resources.

Isolated left anterior descending coronary artery disease

Because the left anterior descending coronary artery supplies more myocardium than the circumflex or right coronary arteries, disease in its proximal portion carries a worse prognosis. When ischaemia is present, revascularisation improves survival⁴ even in asymptomatic patients.⁵ For more than two decades, the most durable and effective option for revascularisation has been an internal mammary artery graft which, unlike vein grafts, is almost immune to the . . . [Full text of this article]

Multivessel coronary artery disease

Implications for health services and for patients

University of Oxford, Oxford OX3 9DU

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