bypass grafting versus medical treatment in angina

Last reviewed 04/2022

Surgery leads to better symptomatic improvement and increased exercise tolerance compared to medical therapy. It is the treatment of choice for patients with left main stem stenosis or three-vessel disease with or without impaired left ventricular function.

Various studies have given valuable information with respect to survival rates comparing surgery and medical therapy:

• the Veterans Administration Study showed a similar survival rate at 11 years for patients with chronic stable angina treated with either medical therapy or surgery

• the European Coronary Surgical Study showed surgery improved survival in patients with 3-vessel disease and patients with 2-vessel disease if there was a lesion in the proximal left anterior descending artery. There were no significant differences in survival in single vessel disease or 2-vessel disease without an LAD lesion

• Coronary Artery Surgery Study - involved patients with mild angina or previous myocardial infarction. Surgery increased survival in patients with impaired left ventricular function