| Abstract: | Patients with coronary artery disease represent a highly heterogeneous group and require individualized treatment based on severity of symptoms, extent and distribution of coronary artery lesions, and left ventricular function. Patients with left main coronary artery disease or triple-vessel disease and left ventricular dysfunction should be referred for surgery, as should patients satisfying the Veterans Administration high-risk group criteria, as well as those patients with intractable symptoms unsuitable for PTCA. Patients in whom discrete proximal lesions in a single coronary artery have caused recent onset of medically refractory angina should be considered for PTCA. In these patients, PTCA has been proven to be both a safe and effective technique. The procedure will relieve the signs and symptoms of myocardial ischemia in half of these patients. One third of this group will have a recurrence of their symptoms but will return to an asymptomatic state for a prolonged period following a second PTCA procedure. The rate of infarction and death compares favorably with that seen with CABG surgery. What are the relative merits of PTCA vs. CABG surgery or drug regimens in the treatment of ischemic heart disease? To answer this critical question, a well-defined prospective randomized clinical trial is needed. The results of such a trial may usher in a new era in the treatment of ischemic heart disease. |
