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(Circulation. 2005;112:1500-1515.)
© 2005 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Is surgery preferred for the diabetic with multivessel disease?

Surgery Is Preferred for the Diabetic With Multivessel Disease

Spencer B. King, III, MD

From the Fuqua Heart Center, Atlanta, Ga (S.B.K.), and Columbia University Medical Center, Center for Interventional Vascular Therapy, New York, NY (G.D., J.W.M.).

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
When angioplasty was first introduced by Andreas Gruentzig in 1977, it was envisioned as a treatment for angina pectoris refractory to medical therapy but applicable to patients who might otherwise have undergone bypass surgery. Assessment of patients before the intervention included exercise stress testing documenting ischemia, and the lesions selected for treatment were those that could be attempted using the primitive balloon angioplasty equipment that was available at that time. As the equipment for percutaneous coronary interventions (PCIs) improved, the technique was expanded to encompass a larger population of patients who otherwise would have been referred for bypass surgery. By 1990, the frequency of coronary angioplasty had increased to equal that of coronary bypass surgery. By the end of the decade, almost twice as many percutaneous interventions were being performed as were coronary bypass surgical procedures.¹ As angioplasty began to infringe on the domain of bypass surgery, there was a call for randomized control trials testing the comparative value of angioplasty in traditionally surgical applications. Andreas Gruentzig proposed such a trial when angioplasty had reached a degree of maturity 6 years after the first procedure was performed. National Heart, Lung, and Blood Institute (NHLBI) funding for the first comparison of bypass surgery and angioplasty was finally obtained, and the Emory Angioplasty versus Surgery Trial (EAST) was begun in 1987, 2 years after Gruentzig’s tragic death.² A second multicenter randomized trial, the Bypass Angioplasty Revascularization Investigation (BARI), was also approved by the NHLBI and was begun 1 year after the initiation . . . [Full Text of this Article]

George Dangas, MD; Jeffrey W. Moses, MD

Spencer B. King, III, MD

George Dangas, MD; Jeffrey W. Moses, MD

Correspondence to Spencer B. King III, MD, JB and Dottie Fuqua Chair of Interventional Cardiology, The Fuqua Heart Center, 95 Collier Rd NW, Suite 2075, Atlanta, GA 30309 (e-mail sking@acri.com), or Jeffrey W. Moses, MD, Columbia University Medical Center, Center for Interventional Vascular Therapy, 161 Fort Washington Ave, IP, 5th Floor, New York, NY 10032 (e-mail jm2456@columbia.edu).

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