High-Risk Cardiac Revascularization and Clinical Trials

Since the first coronary angioplasty procedure was carried out in 1977, there have been many developments in the field of interventional cardiology. As technologies and technique have evolved, the subset of patients considered suitable for percutaneous intervention has correspondingly widened, and non-surgical therapies have become both accepted practice and viable alternatives to surgical myocardial revascularization. Over the years several trials have been designed to test the success of these therapies for patients with multi-vessel obstructive coronary artery disease, and to compare survival rates with those receiving surgical treatment (namely coronary bypass surgery). However, early trials did not include higher-risk patients, the defining features of whom include older age, decreased left ventricular function and, in particular, previous bypass surgery.Recent trials, such as AWESOME, have addressed this imbalance, and more are proposed (i.e. STICH); in the interim, the compilation of information on outcomes of the high-risk patient, as presented in this book, will remain the best source of decision-making for the clinician faced with the common clinical dilemma of surgery versus intervention for those patients who fail medical treatment. Supported by over 100 illustrations, this text examines and compares medical and surgical management of cardiovascular disease for the high-risk cardiac patient. Incorporating comprehensive coverage of relevant trials (and the lessons learnt from them), and examining evolving medical technology (including drug therapy) and the long-term outcome of various forms of management, it is a valuable source of information for the interventional or non-invasive cardiologist, cardiac surgeon, and trainee.Morrison, Douglass Andrew is the author of 'High-Risk Cardiac Revascularization and Clinical Trials' with ISBN 9781841841854 and ISBN 1841841854.