Bmj Usa

BMJ USA: Letter

BMJ 2005; 330 doi: (Published 09 June 2005) Cite this as: BMJ 2005;330:E360

Following are edited excerpts from Rapid Responses generated by this article, all of which can be read in their entirety at


  1. Adam P Fitzpatrick, consultant cardiologist
  1. Manchester Heart Centre, Manchester MRI Oxford Road M13 9WL, UK

There is only one valid randomized trial of coronary bypass surgery versus medical therapy, the US Coronary Artery Surgery Study (CASS). While this was conducted in the 1970s, and arterial conduits were less commonly used, the revolution in medical therapies for patients with ischemic heart disease over the last 30 years has been nothing short of staggering, and surely outweighs this difference in surgical technique substantially….

It seems plausible that the benefits of cardiac surgery, even for the most severe patterns of disease, are small. One in 50 will die within 30 days of their operation, there is still a very substantial risk of cerebral damage or “perturbation,” and patients suffer a …

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