Doing better in more complex patients: Leading the way for QUIP

During the past 30 years, there has been an impressive decrease in the number of deaths that can be attributed to coronary artery disease (CAD). Contributing factors include a reduction of smoking habits, improvements in the medical treatment of CAD and advances in interventional and surgical therapy. In patients with complex multivessel and/or left main CAD, coronary artery bypass grafting (CABG) results in lower rates of long-term mortality, myocardial infarction and repeat revascularization when compared with percutaneous coronary intervention (PCI). Therefore, more than 50 years after its introduction, CABG remains the treatment of choice for the majority of patients with complex stable CAD. In this issue of the Journal, Thorsteinsson et al. report the data of a nationwide Danish CABG registry. All patients who underwent isolated CABG between 1996 and 2012 were included in an analysis of trends of preoperative patient characteristics and shortand long-term mortality. During the study period encompassing 17 years, the profile of those undergoing CABG has changed. There were more octogenarians, a higher prevalence of diabetes and higher rates of previous stroke, alcohol abuse, cancer, heart failure, renal insufficiency and chronic obstructive pulmonary disease. A similar trend was seen between 2000 and 2009 in the USA, where a marked increase in hypercholesterolaemia was also documented. [...]