Why the study?
The evolution of coronary artery bypass grafting requires portrayal within the context of the parallel development of percutaneous coronary intervention.
Key Points
Key points are not available for this paper at this time.
Design
Historical perspective
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The 2021 guidelines were controversial, and they were largely controversial because of the downgrading of coronary artery bypass surgery (CABG) in patients with stable triple-vessel ischemic heart disease—from a class 1 recommendation, which is a very strong recommendation, to a 2B. To justify this, they used the ISCHEMIA study, which in our opinion should not have been used.”
“Coronary artery disease remains a leading cause of morbidity and mortality globally, and coronary revascularization is an important therapeutic option when managing patients with this disease. Treatment recommendations in the guideline outline an evidence-based approach to managing patients … with the intent to improve quality of care and align with patients' interests.”
“We have to focus on the data. The majority of providers are not reading the fine print. They are not focused on the details and the nuances of the guidelines, and when we provide a confusing message to patients,... I think it's detrimental to the overall healthcare of patients. I think that it's our responsibility as physicians to ensure that patients are getting the best therapy for their disease.”
Implication
Caution warranted applying 2021 CABG downgrade in stable 3VD; leaves open optimal revascularization strategy pending dedicated RCT evidence.
Abstract
Coronary artery bypass grafting (CABG) was introduced in the 1960s as the first procedure for direct coronary artery revascularization and rapidly became one of the most common surgical procedures worldwide, with an overall total of more than 20 million operations performed. CABG continues to be the most common cardiac surgical procedure performed and has been one of the most carefully studied therapies. Best CABG techniques, optimal bypass conduits, and appropriate patient selection have been rigorously tested in landmark clinical trials, some of which have resolved controversy and most of which have stoked further debate and trials. The evolution of CABG cannot be properly portrayed without presenting it in the context of the parallel development of percutaneous coronary intervention. In this Historical Perspective, we a provide a broad overview of the history of coronary revascularization with a focus on the foundations, evolution, best evidence, and future directions of CABG.
Discussion
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Cite This Study
Mack et al. (2021) studied this question.