When and why should we employ the surgeon?
Biological and clinical rationale for early reperfusion |
Revascularization in patients with
coronary artery disease (CAD) has
changed over the last two decades,
favoring the use of percutaneous
coronary intervention (PCI) over
coronary artery bypass grafting
(CABG), even though there is no
available hard evidence to support
this change. Nevertheless, PCI
stenting has been progressively expanding
its indications to include
multivessel coronary disease, diabetes
mellitus, and left main stem
coronary artery disease. Proponents
of PCI justify its expansion with the
improvement in restenosis achieved
with drug-eluting stents. However,
the established treatment of CAD is
CABG, with proven long-term life
expectancy benefit. The ongoing
replacement of CABG with PCI
would be therefore justified only if
a critical scrutiny of the evidence
clearly demonstrates similar or better
life expectancy benefits...
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