Second Opinions for Aortocoronary Bypass Grafting Are Beneficial

In 1978, in a review of the experience during the first decade with aortocoronary bypass grafting (ACBG),1we reported that "with the exception of left main coronary artery disease and possibly other subsets of patients... there was inadequate data to justify the premise that ACBG prolongs life." We concluded the review by emphasizing that "despite a decade of experience, embracing 300 000 or more operations, indications for the use of ACBG remain controversial." In 1984, Bourassa and colleagues2reported that there was extensive progression of atherosclerosis in coronary arteries and bypass grafts ten years after surgery. Only about 60% of the grafts remained patent; of those, 45% showed angiographic evidence of atherosclerosis and 70% of those lesions reduced the luminal diameter by 50% or more. They concluded that "because of these progressive late changes, ACBG should probably remain limited to patients with incapacitating anginal syndromes and with severe