Indications for Coronary Artery Bypass Surgery (pp.251-260)
Authors: (Nikolaos Koumallos, Amir Sepehripour, Paul Waterworth, Cardiothoracic Department, University Hospital of South Manchester, United Kingdom)
Abstract: Coronary artery bypass grafting (CABG) has been used in clinical practice for over fifty years as a means of myocardial revascularisation in the setting of coronary artery disease (CAD) and is arguably the most intensively studied surgical procedure ever undertaken. Whilst other techniques of mechanical revascularisation in the form of percutaneous coronary intervention (PCI) as well as optimal medical therapy have been utilised for the management coronary artery disease, CABG has consistently been shown to be superior in achieving the ultimate goals of myocardial revascularisation: symptom relief and improvement of prognosis in the short and long term. However, these results need to be interpreted in the context of the setting in which CABG has a strong indication as first line management.
As understanding of pathology and surgical techniques have improved over the last fifty years so have the surgical outcomes observed with coronary artery bypass grafting. Most significantly are the superior results seen in CABG in comparison to PCI. Various randomised controlled trials and meta-analyses have demonstrated this superiority in the settings of death, myocardial infarction, repeat revascularisation and any other major adverse cardiac or cerebrovascular events, thereby emphasising CABG to be the standard of care in the clinical settings where indicated.