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PTCA versus CABG: a different interpretation of the results of randomised trials comparing both treatments
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The
choice of the most appropriate mode of myocardial revascularisation
remains open in many patients. All randomised trials comparing surgery
(CABG) and angioplasty (PTCA) have shown that both modalities are
equivalent in terms of survival or infarct free survival; but all
showed that patients treated with PTCA required many more admissions
for additional revascularisation procedures during follow up. It was
suggested that patients be informed at the time of their initial
angiography that the PTCA option would mean more subsequent
hospitalisations. The need for reintervention can rightly be seen as
one of the major limitations of any revascularisation procedure. It is
a significant inconvenience for the patient, increases the time away
from a normal active life, and is associated with increased costs. In
the BARI ((bypass angioplasty revascularization investigation)
trial,1 54% of patients randomised to the PTCA arm had
hospital admissions for repeat revascularisation procedures, compared
with only 8% in
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