Turf Battles in Coronary Revascularization

When percutaneous transluminal coronary angioplasty (PTCA) entered mainstream use in the early 1980s, it represented a suboptimal substitute for coronary-artery bypass grafting (CABG). Over time, however, the outcomes of PTCA improved, and the technique became a viable alternative to CABG, even in the treatment of patients with advanced coronary disease. Nevertheless, the extent of the diffusion of PTCA as compared with CABG varied widely among hospitals. Several years after the introduction of PTCA, traditional CABG surgery was faced with a new competitor — minimally invasive cardiac surgery. Although the less invasive technique had clear advantages for some types of patients, . . .