Surgeons allege that fewer coronary artery bypass graft (CABG) operations are being performed because cardiologists are performing more percutaneous coronary intervention (PCI) procedures for monetary gain. The authors reviewed publicly accessible databases from New York State, California, Canada, and Europe for 1997 and 2003. In New York State, the number of CABGs performed fell by one-third. Patient demographics, however, remained unchanged. In contrast, while the number of PCIs substantially increased, the percentage of 3-vessel PCIs remained unchanged. In California, the rate of CABG production (per million population) fell by one-quarter, but it increased in Canada and Europe. In contrast, the rate of PCI production increased in all locations. The performance of fewer CABG procedures in America cannot be entirely explained by cardiologists' increasingly self-referring patients with coronary artery disease for PCI.