Conclusions

Early clinical trials demonstrated surgical revascularisation to be superior to medical therapy in patients with angina and prognostically significant CHD. Subsequent trials demonstrated PTCA to have similar effects on survival compared with medical therapy, but CABG conferred a survival advantage for patients with multivessel CHD, particularly in those with diabetes. Revascularisation rates were consistently greater after PTCA than after CABG. Stenting reduced the need for revascularisation, compared with PTCA, but had no effect on survival or recurrent MI. Recent developments in percutaneous revascularisation, particularly with regard to adjunctive antithrombotic therapies and drug-eluting stents, raise the possibility that the effects of multivessel stenting on survival, and possibly revascularisation in the long term, may be non-inferior to surgical revascularisation.

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