Evidence basis for decision-making between coronary artery bypass grafting and percutaneous coronary intervention

Abstract

Historically, the 15 randomized clinical trials comparing coronary artery bypass graft surgery and percutaneous coronary intervention for intervention in coronary artery disease have been criticized for profound selection bias (‘cherry-picking’ of patients). The stringent clinical and angiographic-based inclusion criteria led to only 2–12% of all screened patients actually being randomized in these trials, resulting in recruitment of mainly low-risk subjects with predominant one- or two-vessel disease (and a low incidence of three-vessel disease), preserved left ventricular ejection fraction, and a low incidence of diabetes. This highly selective selection practice echoes that of a review of 31 antidepressant efficacy trials in 2002, demonstrating that despite the large number of trials and participants, only a minority of patients treated for depression in routine clinical were eligible for inclusion because of a large number of exclusion criteria.