A review of randomized trials comparing coronary angioplasty and bypass grafting.

Angioplasty and bypass surgery have become standard methods of treating patients with symptomatic coronary atherosclerosis. Although both procedures have been applied to a wide spectrum of patients with acceptable morbidity and mortality, only recently have randomized trials been performed to directly compare their efficacies. In patients with multivessel disease, overall mortality and freedom from myocardial infarction appear to be similar between the two treatment strategies. Primarily due to restenosis, the need for repeat revascularization procedures is significantly greater in patients who initially undergo angioplasty. Accordingly, this difference is most striking in the 1st year of follow-up and diminishes over time. The costs of the two treatment strategies reflect the restenosis problem as well. Although angioplasty initially costs less than bypass surgery, the cost savings largely abate after repeat interventions are performed.