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July 14, 2020

Coronary Revascularization Strategies: Making Sense of Sparse, Limited-Quality Data

Author Affiliations
  • 1Cleveland Clinic, Cleveland, Ohio
JAMA. 2020;324(2):154-156. doi:10.1001/jama.2020.8548

The era of coronary revascularization began 53 years ago with the first reported coronary artery bypass graft (CABG) surgery.1 This procedure eventually became the most common major surgical procedure performed in the US, reaching a peak of 519 000 surgical procedures annually in the year 2000. Currently, an estimated 400 000 CABG procedures are performed in the US each year2 at an average cost of $40 000 per operation, for an estimated total expenditure of $16 billion. The first percutaneous coronary intervention (PCI), a balloon angioplasty, was performed 43 years ago, and procedural volume increased exponentially to an estimated 950 000 interventions performed annually in the US, for an estimated total expenditure of $12 billion in 2018.3 Yet, many decades after the introduction of coronary revascularization procedures, considerable controversy remains about their indications, methodology, and efficacy.