Percutaneous transluminal coronary angioplasty versus coronary artery bypass. Isn't it time for a randomized trial?

Ischemic heart disease continues to be the major cause of disability and death in the United States. Despite the availability of effective medications, each year a large number of patients undergo revascularization. In 1983, 191,000 coronary artery bypass operations were reported to the National Hospital Discharge Survey of the National Center for Health Care Statistics. Three multicenter randomized trials comparing medical treatment with coronary artery bypass have shown that bypass surgery significantly relieves symptoms and improves functional capacity but has a smaller effect in terms of prolonging life and little, if any, effect in preventing myocardial infarction.1 2 3 4 An improvement in . . .

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