Coronary Surgery: When, Where and for Whom?

Ideally, therapy for patients with ischemic heart disease should both relieve disabling symptoms and increase life expectancy. Aortocoronary bypass grafts1 can relieve severe angina in most patients2 , 3 but have appreciable immediate costs. The decision about such operations therefore involves balancing these short-term costs (e.g., peri-operative morbidity and mortality) against possible long-term benefits (e.g., relief of pain and prolonged survival). Although the physician caring for a patient with coronary disease can provide advice about these costs and benefits, the ultimate decision must be made by the patient and must depend, in part, upon the relative importance of relief of pain and . . .