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This article reviews the context and evidence of recent myocardial revascularization trials that compared percutaneous coronary intervention with coronary artery bypass grafting for the treatment of left main and multivessel coronary artery disease. We develop the rationale that some of the knowledge synthesis resulting from these trials, particularly with regard to the claimed noninferiority of percutaneous coronary intervention beyond nondiabetic patients with low anatomic complexity, may have been affected by trial design, patient selection based on suitability for percutaneous coronary intervention, and end point optimization favoring percutaneous coronary intervention over coronary artery bypass grafting. We provide recommendations that include holding a circumspect interpretation of the currently available evidence, as well as suggestions for the collaborative design and conduct of future clinical trials in this and other fields.

Original publication

DOI

10.1161/CIRCULATIONAHA.118.035970

Type

Journal article

Journal

Circulation

Publication Date

18/12/2018

Volume

138

Pages

2943 - 2951

Keywords

clinical trials as topic, coronary artery disease, coronary stenosis, percutaneous coronary intervention, surgical procedures, operative, treatment outcomes, Bias, Clinical Trials as Topic, Coronary Artery Bypass, Coronary Artery Disease, Humans, Myocardial Revascularization, Patient Selection, Percutaneous Coronary Intervention