The role of CABG in the era of drug-eluting stents: a surgeon's viewpoint.

Advances in transcatheter technologies, from balloon angioplasty to bare metal stents to drug-eluting stents, have resulted in improved outcomes following percutaneous coronary intervention (PCI). As a consequence, the differences in outcomes between coronary artery bypass graft surgery (CABG) and PCI have become less significant over short-term follow-up. In addition, the number of patients undergoing coronary revascularisation with PCI has increased and far exceeds that of CABG, which has declined, the ratio stabilising in recent years. With the advent of drug-eluting stents and the increasing off-label use of these stents-and in the setting of questionable public awareness of the relative risks and benefits of the therapeutic options of optimal medical treatment and revascularisation by PCI or CABG-the role of CABG requires clarification and reaffirmation. Recent clinical trials have helped to better define the relative benefits of each treatment modality. The mid- and long-term results of these studies remain to be seen, however, while the evidence for the role of PCI in left main stem disease remains inconclusive at the present time. In this context of continually emerging clinical evidence, this review seeks to provide a balanced opinion regarding the role of CABG in the era of drug-eluting stents.