Bypass grafting versus medical treatment in angina

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