Circulation, Vol 57, 405-431, Copyright © 1978 by American Heart Association
HD McIntosh and JA Garcia
Despite a decade of experience with aortocoronary bypass grafting embracing
300,000 or more operations, indications for its use remain controversial.
The controversy persists because of a lack of adequate controls with which
to compare the clinical course of operated patients; only 1248 have been
reported who have been studied in a carefully controlled and random manner.
Benefit has been claimed frequently by comparing the course of patients
treated surgically with medically treated patients followed the decade
before. Such comparisons are not valid in view of the well documented
changes in the natural history of coronary artery disease that have been
occurring during the last decade. Despite a low operative mortality and
rate of graft closure, available data in the literature do not indicate
that initial symptomatic improvement necessarily persists, or that
myocardial infarctions, arrhythmias, or congestive heart failure will be
prevented, or that life will be prolonged in the vast majority of operated
patients.
ARTICLES
The first decade of aortocoronary bypass grafting, 1967-1977. A review
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