Indications for Coronary Artery Bypass Grafting CABG

Patients with left main equivalents (proximal left anterior descending and proximal circumflex artery stenosis), three-vessel disease (irrespective of left ventricular dysfunction), and double-vessel disease with left ventricular dysfunction all appear to have a survival benefit from surgical revascularization in comparison with both medical therapy and angioplasty.

For patients with less-extensive atherosclerosis and preserved left ventricular function, no distinct advantage in terms of survival has been demonstrated for one therapy (medical, angioplasty, or surgery) over another. A high proportion of lower-risk patients included in revascularization trials are alive and angina-free regardless of the initial mode of revascularization for up to 5 years after initial therapy. However, patients who initially undergo CABG surgery have fewer subsequent revascularization procedures, antianginal medicines, or cardiac rehospitalizations than those on medical therapy or those treated initially by angioplasty. A recent study showed only 8% of CABG treated patients required revascularization compared to 34% of those receiving PCTA.

Among patients with unstable angina, electrocardiographic changes with pain, and evidence of left ventricular dysfunction are all indicative of severe ischemia and/ or left ventricular dysfunction and strongly warrant consideration for revascularization depending on coronary artery anatomy. Patients with postinfarction angina are a high-risk group with severe ischemia and left ventricular dysfunction for whom the likelihood that revascularization will be beneficial is strong and logical.

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