Angioplasty, bypass surgery or medical treatment: how should we decide?

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Angioplasty, bypass surgery or medical treatment: how should we decide?

Authors
Publisher
BMJ
Keywords
  • Ra Public Aspects Of Medicine
  • Rc Internal Medicine

Abstract

Pell, J.P. and Denvir, M.A. (2002) Angioplasty, bypass surgery or medical treatment: how should we decide? Heart 88(5):pp. 451-452. http://eprints.gla.ac.uk/4457/ Deposited on: 25 June 2008 Glasgow ePrints Service http://eprints.gla.ac.uk Angioplasty, bypass surgery or medical treatment: how should we decide? J P Pell1, M A Denvir2 1 Department of Medical Cardiology, University of Glasgow, Glasgow, UK 2 Department of cardiology, Western General Hospital, Edinburgh, UK Correspondence to: Dr Martin Denvir, Department of Cardiology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK; [email protected] ABSTRACT Coronary revascularisation continues to be underused despite evidence that this results in poorer outcomes Keywords: angioplasty; coronary artery bypass graft surgery; coronary artery disease Abbreviations: ACRE, appropriateness of coronary revascularisation; CABG, coronary artery bypass graft; CAD, coronary artery disease; PCI, percutaneous coronary intervention There are wide variations in revascularisation rates throughout the UK which cannot be explained by geographical variations in the incidence of coronary artery disease (CAD).1–3 In the USA, intervention rates are double those in the UK.4 Nonetheless, it has been suggested that coronary revascularisation rates may be insufficient in some areas of the USA.5,6 Under provision of revascularisation in some areas may be responsible for preventable morbidity and mortality,7 and inequalities in health. Low rates are a result of poorer access to angiography and specialist services within some areas.8 In the UK, attempts are being made to address this through the appointment of more cardiologists. The ACRE (appropriateness of coronary revascularisation) study used the Delphi method to define, in detail, the criteria by which patients should be selected for coronary angiography and subsequent revascularisati

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