Multiarterial CABG Lowers Mortality and Reinterventions Compared With PCI: Single-Center Study

The debater seems to be unaware of the results of the one and only multicentre prospective study, namely the SYNTAX one, which in a five years run has wonderfuly proved superiority of CABG with arteries over PCI with DES. Therefore to deny the results of the given institution of being a single one is just laughable. In fact, interventional cardiologists do seem to be of ignorant of cardiac surgical literature. If one would take her/his time, to go through the papers of David Taggarts, Guo Wei - just to mention the greatest contemprorary figures of coronary artery surgery, would not ever dare to come out with such declarations. Or, going back a little in time, Mr Homan van deer Heide's, or Dr Sauvage' results with multiple arterial revasularization effective in 15, 20 years, would surely convince the opponents, that surgery in multivessel coronary disease is the treatment of choice. Plus, if these opponents would consider the BIOCHEMICAL BASIS of the longlasting effectivity of the LIMA,RIMA bypass grafts, namely their HIGH PRODUCTION OF NITRIC OXIDE (NO), which is a potent vasodliator, platelet aggregation inhibitor,and primarily a potent agent to transform the recipient coronary artery' endothelium to resist atheroclerotic process, would always refer their multivessel CAD patients to surgery...

I do not completely understand the discussion. The study from Mount Sinai Beth Israel Medical Center reminds us, that the use of multiple arterial grafts provides better results than the use of just one. This message is not so new, if we look at former publications from the Cleveland Group and many others, who all recommended the use of both internal thoracic arteries as superior to just a single one. The question of whether the radial artery is comparably effective as the ITA or not or at least better than a saphenous vein graft is still pending, as this observational study from New York is hardly able to add statistically significant data to this discussion. This is finally also true for the question of whether bypass grafting is superior to PCI in multivessel disease, as an observational study with the use of different and partially no longer contemporary stents can - again - not add any statistically relevant news. The only message to be learned is, that the results of bypass surgery get close to those after PCI if only one arterial graft is used. So let us stay with the results of SYNTAX and let us be reminded by our New York colleagues, that we should reinforce our strengths, as there are multiple arterial grafting and complete revascularization, only to mention some.