CABG versus PCI—‘evidence’ and ‘practice’ not the flip side!

Excerpt

Almost a year of hard work, half perspiration and the rest inspiration of the Guest Editor, Prof. David Taggart and here we are with the special issue on ‘Surgical Myocardial Revascularisation’. This issue was mooted as coronary artery bypass grafting (CABG) surgery has not been given a fair deal and the volumes have been dwindling. Newer techniques and advances are not being highlighted and not adequate stress has been paid on total arterial revascularisation (TAR). More literature on CABG seems to have emanated from cardiology journals than surgical. No wonder then, that it is more often than not skewed, if not blatantly biased. Whenever percutaneous coronary intervention (PCI) is compared with CABG, it is the best of stents, in the best of hands, in high-volume centres, under the rigours of a trial setting, versus, by default, a ‘run of the mill’ left internal mammary artery-left anterior descending (LIMA-LAD) and balance saphenous vein revascularisation, which we all know is an archaic sub-optimum surgery. PCI should be compared to TAR, and the latter should in fact become a quality metrics for myocardial revascularisation. Further, the trial should not be abbreviated, but allowed to run through a period sufficient to allow events, which should be cardio-specific and meaningful such as survival, to unfold. Therefore, even guidelines, which are based on these trials, do not guide us, and though they may look balanced in ‘letter’, but certainly are not well intended in ‘spirit’. This featured issue thus attempts to present what an ideal CABG operation should and could be, if we stuck to the right tenets and principles of surgical myocardial revascularisation. That is the only way, of leading from the front, that the lost glory of CABG can be restored, and PCI challenged, and if not stopped, at least fathomed in its tracks. PCI certainly has a salutary complementary role to CABG, and that is where it should be, in the pecking order of myocardial revascularisation. …