Chapter 27. Surgical Coronary Artery Revascularization

  1. Salim Yusuf DPhil, FRCPC, FRSC Research Chair Professor of Medicine Director Vice President Research2,3,4,
  2. John A Cairns MD, FRCPC Professor of Medicine Former Dean5,
  3. A John Camm MD British Heart Foundation Professor Head of Cardiac6,
  4. Ernest L Fallen MD, FRCPC Professor Emeritus7 and
  5. Bernard J Gersh MB, ChB, DPhil Consultant Professor of Medicine8
  1. Morgan L Brown MD Research Fellow and
  2. Thoralf M Sundt III MD Consultant Professor of Surgery

Published Online: 21 MAY 2010

DOI: 10.1002/9781444309768.ch27

Evidence-Based Cardiology, Third Edition

Evidence-Based Cardiology, Third Edition

How to Cite

Brown, M. L. and Sundt, T. M. (2009) Surgical Coronary Artery Revascularization, in Evidence-Based Cardiology, Third Edition (eds S. Yusuf, J. A. Cairns, A. J. Camm, E. L. Fallen and B. J. Gersh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444309768.ch27

Editor Information

  1. 2

    McMaster University, Canada

  2. 3

    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Canada

  3. 4

    Hamilton Health Sciences, Hamilton, Ontario, Canada

  4. 5

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

  5. 6

    St George's University of London, London, UK

  6. 7

    McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

  7. 8

    Mayo Clinic College of Medicine, Rochester, MN, USA

Author Information

  1. Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

Publication History

  1. Published Online: 21 MAY 2010
  2. Published Print: 13 NOV 2009

ISBN Information

Print ISBN: 9781405159258

Online ISBN: 9781444309768



  • Coronary artery bypass grafting versus medical management;
  • Coronary artery bypass grafting versus ercutaneous interventions;
  • left anterior descending (LAD);
  • angiotensin - converting enzyme (ACE);
  • Coronary Artery Surgery Study (CASS);
  • On-pump and off-pump coronary artery bypass grafting;
  • Left anterior small thoracotomy procedure;
  • right internal thoracic artery (RITA);
  • (bilateral) internal thoracic arteries (BITA);
  • inferior gastroepiploic artery (IEA)


The management of chronic stable angina has undergone considerable evolution over the past two decades. This review highlights the need for a comprehensive approach to management, which includes careful identification of cardiac risk factors, use of therapeutic lifestyle interventions (especially in high-risk patients with diabetes mellitus or metabolic syndrome), aggressive, multifaceted medical therapy, and the judicious use of myocardial revascularization. Traditional anti-ischemic therapy continues to comprise aspirin, beta-blockers and calcium channel blockers, along with adjunctive therapies that include statins and ACE inhibitors. Ranolazine is a novel anti-anginal and anti-ischemic agent that has promise in reducing refractory ischemia and as add-on therapy for patients who ischemia cannot be optimally controlled with standard anti-ischemic agents. The role of coronary artery bypass graft surgery and percutaneous coronary intervention (PCI) in the management of the chronic stable angina patients is discussed, as are the clinical implications of the COURAGE Trial. The combined use of both a “focal” approach (PCI to treat the culprit stenosis) and a “systemic” approach (lifestyle intervention and aggressive pharmacotherapy with comprehensive secondary prevention) may afford the best opportunity to enhance event-free survival and optimize clinical outcomes in patients with chronic coronary artery disease and stable angina.