Analysis of trials of surgery vs angioplasty in myocardial revascularization.
OBJECTIVE
comparison of surgery and angioplasty for the treatment of coronary artery disease.


METHODS
comparison using randomized trials for low-risk patients and observational studies for high-risk patients.


RESULTS
in low-risk patients, a strategy of initial surgery or angioplasty achieved similar results regarding overall and infarct-free survival rates at 5 years. Residual angina was statistically more prevalent after angioplasty and required more subsequent revascularization procedures. Residual angina negatively impacted on life quality. Angioplasty initially had a cost-effectiveness advantage over surgery, which subsided over time. In high-risk patients, no firm conclusion could be drawn, due to unmatched selection of patients. Angioplasty seems superior in acute myocardial infarction and in very ill patients. Surgery seems superior to treat diseased bypass grafts.


CONCLUSIONS
because of similar achievements, the choice of therapy in low-risk patients eventually should depend on patient's preference. During counselling, the deleterious effect of residual angina on life quality and health perception should not be underestimated by practitioners. In high-risk patients, further studies are required to define the best approach to any individual patient.
Prêtre
R
R
Cardiovascular Surgery, University Hospital, Zürich, Switzerland. rene.pretre@chi.usz.ch
Turina
M I
MI
D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome