From the Guidelines
Coronary artery bypass grafting (CABG) is indicated for patients with significant left main disease, high anatomic complexity coronary artery disease (CAD), or those with reduced left ventricular function (EF <50%) who are suitable candidates for CABG. The indications for CABG can be broken down into several key categories, including:
- Anatomic indications to improve survival, such as left main disease or significant left main stenosis and high anatomic complexity CAD 1
- Indications to improve symptoms, such as refractory angina on medical therapy, or revascularization in patients with stable ischemic heart disease (SIHD) 1
- Patients with ischemic cardiomyopathy and EF <50% are also suitable candidates for CABG, as it can improve survival and reduce symptoms 1
- Additionally, CABG may be indicated in patients with multivessel CAD, especially those with diabetes mellitus, complex coronary anatomy, or those who have failed or are unsuitable for percutaneous coronary interventions 1
The decision to proceed with CABG should be individualized, considering the patient's overall clinical status, comorbidities, coronary anatomy, and preferences, ideally through a heart team approach involving cardiologists and cardiac surgeons 1. The goal of CABG is to improve survival, prevent myocardial infarction, improve left ventricular function, and relieve angina symptoms, ultimately enhancing the patient's quality of life.
In patients with reduced left ventricular function (EF <35%), CABG is recommended as the preferred treatment option 1. For those with EF 35%-50%, CABG is also a suitable option, although a heart team discussion may be necessary to determine the best course of treatment 1.
Overall, the indications for CABG are based on a comprehensive evaluation of the patient's clinical status, coronary anatomy, and preferences, with the goal of improving survival, reducing symptoms, and enhancing quality of life.
From the Research
Indications for Coronary Artery Bypass Grafting (CABG)
The indications for CABG include:
- Patients with stable angina who have left main coronary artery disease; three-vessel disease; three or four of the clinical variables set forth in the Veterans Administration Cooperative Study; obstruction in proximal third of left anterior descending coronary artery as part of two- or three-vessel disease; and two- or three-vessel disease and exercise-induced ischemic ST-segment depression greater than or equal to 1.5 mm 2
- Patients with unstable angina who have an inadequate response to intensive medical therapy, and those with rupture of the ventricular septum, acute severe mitral regurgitation, and cardiogenic shock with vessels suitable for CABG 2
- Patients with postinfarction angina after the first few days following acute myocardial infarction, especially non-Q-wave infarction 2
- Patients with coronary artery disease, especially those with a significant amount of ischemic myocardium, who must undergo cardiac surgery for valvular heart disease or for congenital heart disease 2
- Patients with multivessel disease, as CABG is associated with better survival, lower rates of major cardiovascular events, and repeat revascularization compared to percutaneous coronary intervention (PCI) 3, 4
- Patients with left main coronary artery disease, as CABG has been considered a standard indication for nearly 3 decades due to its survival advantage over medical therapy 5
Patient Selection and Graft Selection
Patient selection and graft selection are crucial in optimizing outcomes in CABG: