What are the indications for Coronary Artery Bypass Grafting (CABG)?

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:

• Left main disease, which is a significant indicator for CABG due to the high risk of mortality associated with this condition 1
• High anatomic complexity CAD, which may not be adequately managed with percutaneous coronary intervention (PCI) or medical therapy alone 1
• Reduced left ventricular function (EF <50%), which increases the risk of mortality and morbidity in patients with CAD, making CABG a more suitable option 1
• Patients with diabetes mellitus and multivessel disease, as well as those with complex coronary anatomy unsuitable for stenting, may also benefit from CABG 1
• Refractory angina despite optimal medical therapy, or significant ischemia on non-invasive testing, are also indications for CABG 1

The decision for CABG should be individualized, considering the patient's overall health status, comorbidities, and preferences, ideally through a heart team approach involving cardiologists and cardiac surgeons 1. The goal of CABG is to improve survival, reduce symptoms, and enhance quality of life for patients with significant coronary artery disease.

Key considerations for CABG include:

• The presence of significant left main stenosis and high anatomic complexity CAD, which are strong indicators for CABG 1
• The suitability of the patient for CABG, taking into account their overall health status, comorbidities, and preferences 1
• The use of a heart team approach to make individualized decisions about CABG, considering the latest evidence and guidelines 1

From the Research

Indications for Coronary Artery Bypass Grafting (CABG)

The indications for CABG are as follows:

• Unprotected left main disease (ULMD) with complex coronary anatomy (SYNTAX >22) 2
• Multivessel coronary artery disease (CAD) with complex coronary anatomy (SYNTAX >22) 2
• Left ventricular dysfunction (LVD) with complex coronary anatomy (SYNTAX >22) 2
• Diabetes with multivessel CAD, as CABG is associated with improved long-term survival and lower cardiac events 2
• Patients with severe coronary artery disease who are not suitable for percutaneous coronary intervention (PCI) 3

Patient Selection

Patient selection for CABG is based on various factors, including:

• Clinical characteristics, such as diabetes and LVD 2
• Anatomical complexity, using the SYNTAX score 2, 4
• Surgical risk, with CABG being preferred for patients with low to intermediate surgical risk 4
• Patient preferences, with some patients preferring CABG over PCI based on their personal experience 5

Graft Selection

The choice of graft for CABG is also important, with:

• Multiple arterial grafting being associated with better long-term outcomes 6
• Anaortic techniques being used to minimize the risk of stroke 6

Optimizing Outcomes

To optimize outcomes for patients undergoing CABG, a multidisciplinary heart team approach is recommended, taking into account:

• Patient clinical characteristics and anatomical complexity 2, 4
• Surgeon and team experience 6
• Individualized surgical approach 6