Underuse of Coronary Revascularization Procedures

To the Editor: Hemingway et al. (March 1 issue) 1 conclude that, according to criteria set by an expert panel, coronary revascularization procedures are underused; patients who should have undergone a surgical intervention were incorrectly treated medically. But what is the basis for the criteria of the expert panel? Current recommendations regarding surgery are derived largely from data from the 1970s and early 1980s, 2 which preceded the development of aggressive medical therapies both for the management of ischemia (e.g., nitrates and beta-blockers) and for the reduction of risk factors (especially cholesterol levels). Even the most recent study comparing surgical treatment with . . .