What is one indication for coronary artery bypass graft (CABG) surgery?

• A. Single vessel disease
• B. Two vessel disease
• C. Three vessel disease or left anterior descending artery with greater than 70% stenosis
• D. Asymptomatic patients requiring monitoring

Answer: (C)

Coronary artery bypass graft (CABG) surgery is typically indicated in cases of significant coronary artery disease where revascularization is necessary to alleviate symptoms or to improve outcomes. The specific scenario of three vessel disease or significant lesion in the left anterior descending artery (LAD) with greater than 70% stenosis is particularly compelling. This condition indicates extensive disease that poses a high risk for future cardiac events, such as myocardial infarction, especially in patients with compromised heart function.

In cases of three vessel disease, the heart is not receiving adequate blood supply, leading to ischemia during physical exertion or even at rest. The left anterior descending artery, responsible for feeding a large portion of the heart muscle, is critical; lesions here can significantly impact cardiac function. Therefore, intervention through CABG can restore adequate blood flow, relieve symptoms like angina, and ultimately improve the patient’s quality of life and longevity.

Other indications such as single vessel or two vessel disease, while potentially suitable for percutaneous interventions like stenting, do not necessarily warrant CABG, especially if the lesions are less extensive and the patient’s left ventricular function is preserved. Asymptomatic patients or those requiring monitoring generally do not meet the threshold for surgical intervention unless they have high