The full content of Annals is available to subscribers

Subscribe/Learn More  >
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, Author, and Disclosure 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
Text Size: A A A

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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.