Coronary artery bypass surgery vs coronary angioplasty: from antithesis to synthesis.

Over the last two decades, revascularization therapy has greatly improved the management of patients with coronary artery disease. Coronary artery bypass graft (CABG) surgery has been proven by several randomized trials to alleviate symptoms, prevent myocardial infarction, and prolong survival in patients with moderately severe disease. Percutaneous transluminal coronary angioplasty (PTCA) has emerged as an alternative treatment for an increasing number of these patients. The use of coronary angioplasty has been expanding rapidly to include single-vessel and multivessel disease and acute ischaemic syndromes. Although the angiographic success rate in properly selected cases exceeds 90%, there are limited data regarding the long-term results with angioplasty in the treatment of patients with multivessel disease. Procedure-related mortality and restenosis rate remain major areas of concern. Several randomized clinical trials (CABRI, RITA, GABI, EAST, BARI) currently in progress are comparing PTCA and CABG in the management of patients with multivessel coronary artery disease. It is anticipated that these studies will provide a wealth of information, enabling physicians to construct a revascularization strategy that will maximally benefit their patients.