The need to improve the appropriate use of coronary revascularization: challenges and opportunities.

We stand at the precipice of extraordinary changes in medicine. Prior generations of physicians sought to apply any and all treatments available to preserve the health and functioning of patients, despite incomplete knowledge of disease processes and the evidence base to know the efficacy of alternative treatment strategies. Over the past 4 decades, an explosion of technology and treatments, with varying degrees of clinical evidence to support or refute their value, have been introduced. Congruent with these changes has emerged an unsustainable explosion in the costs of care, such that the economic future of the entire nation seems to be held hostage to “bending the cost curve” and creating a more sustainable model of lowering costs and maximizing