Surgical coronary artery bypass grafting (CABG) was first performed
in 1967 and percutaneous transluminal coronary artery angioplasty (PTCA) in
1977. Initially the 2 revascularization methods appeared complementary: the
less invasive PTCA seemed suited for patients with limited lesions, and CABG
for those with diffuse disease. The Duke University group, in a large prospective
study, first established that PTCA achieved the greatest survival benefit
in patients with a single-vessel disease other than proximal left anterior
descending (LAD) artery stenosis, and CABG in those with multivessel disease
or proximal LAD artery stenosis. Patients with 2-vessel disease or an isolated
proximal LAD artery stenosis had similar results with either therapy.1,2 However, individual clinical variables,
such as the characteristics of the stenosis, the patient's ventricular function,
and associated comorbidities, are often factored into the final decision about
the method of revascularization. In the 1990s, a number of randomized trials
attempted to refine the indications for PTCA vs CABG in patients who could
concurrently be approached by both methods.
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