Coronary artery bypass grafting versus percutaneous coronary intervention in ischaemic heart failure. Can reliable treatment decisions in high-risk patients be based on non-randomized data?

This editorial refers to ‘Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)’, by S. Völz et al. doi:10.1093/eurheartj/ehab273.

Since the RITA trial,1 the first randomized study comparing percutaneous with surgical revascularization for coronary artery disease (CAD), was published in 1993 controversy has endured over the optimal treatment strategy—be it pharmacological, or revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)—for various types of patients with CAD. Based on previous studies, several factors have been identified and proposed as key elements in deciding between the two, and in the context of precision or personalized medicine, some risk models incorporating these factors are presently advocated to predict and quantify the overall risk of one modality of revascularization vs. the other.2–5 These models can therefore assist the Heart Team in deciding the most appropriate revascularization strategy.

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