Turndown for coronary artery bypass surgery: Never say never to revascularization

In this issue of Catheterization and Cardiovascular Interventions, Farag et al. reported their experience comparing patients with acute coronary syndrome versus stable angina patients who were turned down for bypass surgery and subsequently treated with coronary stenting (1). Key points Patients who are considered ineligible for bypass surgeryare often elderly with complex coronary disease, numerous comorbidities and areexpected to have high surgical mortality Several observational studies have reported feasibilityand safety with performing percutaneous coronary interventions (PCI) inpatients considered ineligible for surgery Outcomes with PCI seem to be reasonable; mortality may belower than that expected with bypass surgery and angina is improved. However,studies comparing PCI to medical therapy alone in these high risk patients arenot available.