Which indications for coronary artery bypass grafting (CABG) are associated with a survival benefit over medical therapy?

Updated: Dec 04, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Alexander and Smith in the New England Journal of Medicine noted the following indications for CABG are associated with a survival benefit over medical therapy, with or without percutaneous coronary intervention (PCI) include [23] :

  • Acute ST-segment elevation myocardial infarction (STEMI)

  • CAD other than acute STEMI

  • Coronary anatomy not amenable to PCI

  • Mechanical complications, such as ventricular septal defect, rupture of the free ventricular wall, or papillary-muscle rupture with severe mitral regurgitation

  • Left main disease of 50% stenosis or greater, and intermediate or high complexity for PCI (Synergy Between PCI with TAXUS and Cardiac Surgery [SYNTAX] score ≥33)

  • Three-vessel disease of 70% stenosis or greater, involving the LAD and intermediate or high complexity for PCI (SYNTAX score ≥23)


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