[Ischemia--reliable results of therapy, operation and angioplasty--in coronary disease].

Randomized studies have shown that coronary bypass-surgery is effective in prolonging survival and reducing symptoms in various groups of patients with coronary artery disease, when compared with medical therapy alone. This effect is most pronounced and stable in patients who received an internal-mammary-artery graft. Therefore internal-mammary-artery grafting for lesions of the left anterior descending coronary artery is preferable whenever indicated and technically feasible. While percutaneous transluminal coronary angioplasty is effective in improving symptoms of angina pectoris, beneficial effects on survival have not yet been shown. In randomized trials of PTCA versus bypass-surgery acute results were comparable. During follow-up significantly less re-interventions and more angina-free patients were seen in the bypass-groups, indicating a more stable result after bypass surgery. In older patients with a higher mortality and rate of cerebral vascular events during surgery, a palliative PTCA of the culprit lesion may be superior to the bypass-operation. For the often used "unproven" indications for PTCA (silent ischemia, infarct-related artery in asymptomatic patients, isolated proximal LAD-stenosis, acute myocardial infarction, cardiogenic shock) larger randomized trials should be awaited to prove the effectiveness of PTCA in these settings.

RCT Entities:   Population Interventions Outcomes