Indications of coronary artery bypass grafting

The treatment of coronary heart disease is divided into drug therapy, drug interventional therapy (PTCA and PCI) and surgical treatment. Surgery, namely coronary artery bypass grafting (CABG), is the last resort to treat coronary heart disease, and its indications are not fixed. With the development of medical and surgical techniques, the indications will also change. The American Heart Association (ACC)/ American Heart Association (AHA) issued guidelines for the treatment of coronary heart disease, which are frequently updated and based on the principles of evidence-based medicine, specifically discuss the indications for surgical treatment of coronary heart disease. Generally speaking, patients with coronary heart disease may be suitable for surgical treatment when drug therapy and drug intervention therapy are ineffective, inappropriate, obviously ineffective or extremely risky. 1, stable angina pectoris: angina pectoris affects daily life and work, and conservative medical treatment is ineffective. Coronary angiography showed that the proximal end of the main coronary artery or anterior descending branch/circumflex branch was obviously narrowed by more than 70%, and the three coronary arteries were diseased, especially those with low left ventricular ejection fraction. 2. Unstable angina pectoris: Typical angina affects daily life and work, and conservative medical treatment is ineffective. Coronary angiography showed that the main coronary artery or the proximal end of anterior descending branch/gyrus was obviously narrowed > 70%. 3. After myocardial infarction: drug intervention failed, the patient's symptoms persisted, the hemodynamics was unstable, and he was complicated with ventricular aneurysm, mitral insufficiency and ventricular septal defect. 4. Severe coronary artery stenosis: Patients with severe coronary artery stenosis (the degree of stenosis exceeds 75%) in three main branches of coronary artery (anterior descending branch, circumflex branch and right coronary artery) can consider surgery regardless of the severity of symptoms. 5. Fatal ventricular arrhythmia caused by coronary heart disease, such as left main artery or coronary artery disease. 6. Cases of medical intervention failure. 7. Cases that have received coronary artery bypass grafting in the past, have symptoms and are ineffective in non-surgical treatment. In 2005, ACC (American Heart Association) /AHA (American Heart Association) guidelines pointed out that coronary artery bypass grafting was the first choice in the following situations: left main coronary artery disease; All three coronary artery lesions (left anterior descending branch, right coronary artery and left circumflex branch); Diffuse diseases that are not suitable for interventional therapy. The CABG guideline of ACCF (American Heart Association Foundation) /AHA (American Heart Association) 20 1 1 year further points out that coronary artery bypass grafting is the first choice for patients with other high-risk diseases such as severe cardiac insufficiency (such as low ejection fraction) or diabetes.