Indications for coronary artery bypass surgery and percutaneous coronary intervention in chronic stable angina: review of the evidence and methodological considerations.

By 2000, more than 1 202 000 percutaneous and 519 000 surgical revascularization procedures were being performed annually in the United States.1 The 3 potential reasons to recommend myocardial revascularization are (1) to alleviate symptoms of myocardial ischemia, (2) to reduce the risks of future mortality, and (3) to treat or prevent morbidities such as myocardial infarction, arrhythmias, or heart failure. To minimize biases, this article focuses on data from prospective, randomized, controlled trials (RCTs) comparing coronary artery bypass graft (CABG) surgery, percutaneous transluminal coronary angioplasty (PTCA), stents, and medical therapy for chronic coronary artery disease (CAD). The data are interpreted in the context of a conceptual framework based on patient risk, methodological characteristics of the evidence, and the occurrence of clinically relevant end points.