Surgery is the best intervention for severe coronary artery disease

Introduction

For the past two decades coronary artery bypass grafting has been the standard treatment for patients with severe multivessel ischaemic heart disease.1 In the past few years, however, it has been increasingly challenged by percutaneous coronary intervention. Indeed, in many parts of the developed world percutaneous coronary intervention is done twice as often as coronary artery bypass grafting. Why has this change in practice occurred? I believe that it is not evidence based, does not represent best value for money, and that patients are not appropriately informed of its limitations.

Research evidence

Coronary artery bypass grafting is probably the most intensively studied surgical procedure, with follow up data extending over 20 years.2 It is highly effective in relieving the symptoms of ischaemic heart disease and improving life expectancy in patients with certain anatomical patterns of disease; these benefits are magnified in patients with more severe disease and with impaired left ventricular function.1 Furthermore, coronary artery bypass grafting is remarkably safe. Improvements in medical, anaesthetic, and surgical management have ensured that hospital mortality has remained around 2% over the past decade despite the treatment being used in older and sicker patients.3

On the other hand, …