PROVEN RESULTS OF BYPASS-SURGERY AND ANGI OPLASTY FOR ISCHEMIC CORONARY-ARTERY DISEASE

Randomized studies have shown that coronary bypass-surgery is effectiv e in prolonging survival and reducing symptoms in various groups of pa tients with coronary artery disease, when compared with medical therap y alone. This effect is most pronounced and stable in patients who rec eived an internal-mammary-artery graft. Therefore internal-mammary-art ery grafting for lesions of the left anterior descending coronary arte ry is preferable whenever indicated and technically feasible. While pe rcutaneous transluminal coronary angioplasty is effective in improving symptoms of angina pectoris, beneficial effects on survival have not yet been shown. In randomized trials of PTCA versus bypass-surgery acu te results were comparable. During follow-up significantly less re-int erventions and more angina-free patients were seen in the bypass-group s, indicating a more stable result after bypass surgery. In older pati ents with a higher mortality and rate of cerebral vascular events duri ng surgery, a palliative PTCA of the culprit lesion may be superior to the bypass-operation. For the often used ''unproven'' indications for PTCA (silent ischemia, infarct-related artery in asymptomatic patient s, isolated proximal LAD-stenosis, acute myocardial infarction, cardio genic shock) larger randomized trials should be awaited to prove the e ffectiveness of PTCA in these settings.