Some comments on the indications for the coronary artery bypass graft operation.

Although the indications for coronary artery bypass grafting are clear in some subsets of patients (left main coronary artery, 3-vessel disease with impaired left ventricular function), in others considerable uncertainty persists and is related to lack of sufficient information for making patient specific comparisons of outcomes after competing forms of treatment. These comparisons need to be time related, and to emphasize not only the treatment providing the most favorable outcome, but also the magnitude of the difference in outcome as well as the degree of certainty that the difference is not related to chance alone. With appropriate data, analyses can be performed to provide highly useful patient specific comparisons of outcomes after competing forms of treatment. Such predictions and comparisons suggest the possibility that coronary artery bypass grafting would ideally be indicated while left ventricular function remains good but extensive 3-vessel disease exists. In the future, emergency coronary artery bypass grafting operations, and other special modes for myocardial management, may play a more frequent role in preserving left ventricular function in patients with acute myocardial infarctions.