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Diagnosis and Treatment |

Myocardial Revascularization for Chronic Stable Angina: Analysis of the Role of Percutaneous Transluminal Coronary Angioplasty Based on Data Available in 1989

John B. Wong, MD; Frank A. Sonnenberg, MD; Deeb N. Salem, MD; and Stephen G. Pauker, MD
[+] Article and Author Information

Grant Support: In part by a contract from the American College of Physicians, a grant from the John A. Hartford Foundation, and grants TG15 LM 7044 and LM 4493 from the National Library of Medicine, Bethesda, Maryland.

Requests for Reprints: Stephen G. Pauker, MD, New England Medical Center, 750 Washington Street, Boston, MA 02111.

Current Author Addresses: Drs. Wong, Salem, and Pauker: New England Medical Center, 750 Washington Street, Boston, MA 02111.

Dr. Sonnenberg: UMDNJ/Robert Wood Johnson Medical School, 97 Patterson Street, New Brunswick, NJ 08903.


© 1990 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1990;113(11):852-871. doi:10.7326/0003-4819-113-11-852
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No prospective, randomized clinical trial comparing coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and conservative therapy has been reported. To address when revascularization is indicated, we constructed a decision analytic model. Our model incorporates procedure-related mortality and morbidity, coronary artery disease-related mortality, and the benefit of revascularization. We determined the qualityadjusted life expectancy and expected costs for each strategy. Our model suggests that angioplasty is a reasonable alternative to bypass surgery in patients with favorable lesions if angioplasty would provide a comparable degree of revascularization. Our model predicts that patients treated with angioplasty will have more revascularization procedures than will patients treated with bypass surgery but predicts that both treatments will cost the same over the typical patient's lifetime. In many patients with severe angina or documented ischemia, angioplasty is indicated for stenosis of a single artery. In patients with two vessel disease that is amenable to angioplasty, angioplasty may be a reasonable alternative to bypass surgery. Even in patients whose three vessel disease can be completely revascularized by angioplasty, bypass surgery, although relatively expensive, is slightly better than angioplasty. In patients with three vessel disease and comorbidities that increase operative risk, angioplasty may be a reasonable alternative to either bypass surgery or medical therapy.

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