In Reply We thank JAMA Cardiology for the opportunity to respond to the comments provided by Cheney and Hira. We appreciate their interest in our article.1
We agree that the techniques of percutaneous coronary intervention (PCI) have improved with new-generation drug-eluting stents, fractional flow reserve, optical coherence tomography, and intravascular ultrasonography, which have collectively resulted in lower rates of in-stent restenosis and potentially in improved clinical outcomes. We also agree with Cheney and Hira that clinical registry data typically lack granular details, such as the SYNTAX score. Our study demonstrated that in patients with coronary artery disease and severely reduced left ventricular ejection fraction, those who underwent coronary artery bypass grafting (CABG) vs PCI differed in terms of perioperative and long-term morbidity, mortality, completeness of revascularization, and the need for reintervention.1 As stated in the Discussion section of our article, a randomized clinical trial using modern CABG and PCI practices—as well as capturing detailed anatomic information—appears warranted in this high-risk patient population.