BMJ  2007;335:111 (21 July), doi:10.1136/bmj.39273.655694.BE

Letters

To stent or not to stent?

A sterile debate

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

Did the recent BMJ articles improve the evidence for the superiority of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) as claimed?^{1 2 3} In 2006 the featured minimally invasive direct coronary artery bypass graft (MIDCAB) operation for isolated left anterior descending disease accounted for less than 0.5% of 24 000 CABG procedures in the United Kingdom.^{1 2} Equally the economic arguments apply to practice and hospital costs 10 years ago,³ when PCI strategies were limited, first generation stents were more expensive, and 2-3 days in hospital were considered necessary for safe practice. However, in a current contest between the two procedures 3-5 PCIs more reasonably equate to one CABG.

Currently CABG achieves lower reintervention rates and marginally better survival in multivessel disease with a left main stem lesion. Diabetic patients with diffuse three vessel disease fare better with CABG. Some who are unsuitable for PCI are also poor CABG candidates . . . [Full text of this article]

John Radcliffe Hospital, Oxford OX3 9DU

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Rapid Responses:

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To stent or not to stent? By no means a sterile debate.

Michael R Chester, et al.
bmj.com, 26 Jul 2007 [Full text]