Talk:Coronary artery bypass

You're a braver man than I, Gunga Din...:-)

Having both professional and personal (been there, done that, got the chest zipper and Cardiac Rehab T-shirt), I'd be a lot more cautious about flatly stating CABG is superior to PTCA, and, indeed, possibly throwing in intensive medical management of CAD vs. PTCA. Stenting just complicates it; I know interventional cardiologists who tend to get inflamed if one compares non-drug-eluting to drug-eluting stents (they get violent when they hear the direct-to-consumer advertising of any stent).

Comparing the various interventions also gets tricky with respect to study period. For example, there's much more current emphasis on using an internal mammary article graft at the first CABG; when I had mine, the reasoning was to use saphenous vein only, since I was relatively young and the assumption was that reoperation would be needed for the eventual restenosis. Now, I think the consensus is that if the IMA is used early, the rate of restenosis is vastly less, so there is less need for a "spare part".

Restenosis, and perhaps genetically determined collateralization (I'm apparently lucky there), may need to get into this, since that's one of the major complications and an urgent need to prevent. Howard C. Berkowitz 13:13, 3 April 2009 (UTC)

There are specific and accepted circumstances where one can clearly and easily say that CABG is better than stenting. 2 that come to mind are 3-vessel disease and Left main dz. Tom Kelly 04:49, 4 April 2009 (UTC)

Clearly, there are Class I cases such as you cite, but, for less extensive CAD, the studies keep coming back with mixed results. Howard C. Berkowitz 05:05, 4 April 2009 (UTC)