Medical Perspectives in Coronary Artery Surgery—A Caveat

Abstract

Coronary atherosclerosis is highly prevalent in the United States and is a major cause of death. Various surgical procedures for symptomatic occlusive coronary atherosclerosis have been attempted for more than a half century. Bypass grafting of the coronary arteries has been done for less than 10 years but has been more widely applied than any other procedure for occlusive coronary artery disease. Bypass grafting has already become a therapeutic intervention of considerable economic and logistic significance before its beneficial effects have been firmly established. In this article, review of the history of surgery for, and the natural history of, symptomatic coronary atherosclerosis provides a background for critical evaluation of the immediate results of coronary artery bypass grafting and the evidence bearing on its late effect on morbidity and mortality. Recommendations are formulated for the surgical management of chronic stable angina pectoris, unstable angina, Prinzmetal's angina, disease of the main left coronary artery, acute myocardial infarction and its complications, asymptomatic coronary artery disease, and valve replacement when occlusive coronary artery disease coexists.