Coronary angioplasty compared with bypass grafting

Since coronary-artery bypass grafting was introduced by Favaloro in 1969,¹ its results have improved steadily even though the procedure has been performed increasingly in patients whose operative risk is relatively high because of advanced age, impaired left ventricular systolic performance, or extensive coronary artery disease.² The improvement has been due, at least in part, to the routine use of internal-thoracic-artery conduits³ and antiplatelet therapy,⁴ as well as better intraoperative protection of the heart. When the procedure is performed electively in patients at low risk, mortality is only about 1 percent.⁵ In randomized comparisons with medical therapy in patients with stable…