J.Jpn. Surg. Soc.. 124(4): 317-323, 2023

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Feature topic

CORONARY ARTERY BYPASS GRAFTING VS. PERCUTANEOUS CORONARY INTERVENTION AND DRUG THERAPY

The results of landmark trials have led to three principles (the fundamental triad) regarding the treatment effects of coronary artery bypass grafting (CABG): 1) CABG is effective in preventing all-cause mortality (mortality prevention); 2) the strategy of prior treatment is correct when surgery is indicated because the effect is preventive (going first); and 3) the magnitude of the treatment effect of CABG using the internal thoracic artery increases over time (gradual increase). The highest level of current evidence can be summarized in one sentence on the all-cause mortality-preventive effect of CABG under optimal medical therapy: Adoption of an initial CABG strategy for 2-, 3-, and main stem lesions that are amenable to left internal thoracic artery grafting of the left anterior descending coronary artery (LITA-LAD) bypass results in a 2–3% reduction in 5-year all-cause mortality compared with nonadoption (e.g., initial aggressive medical therapy alone or with additional percutaneous coronary intervention to improve anginal symptoms). The therapeutic benefit of coronary artery bypass surgery using the internal thoracic artery increases over time during the lifetime of the patient and can be expected to increase to 4–5% at 10 years, 6–7% at 15 years, and 8–9% at 20 years.

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