Surgery for coronary artery disease

Ischaemic heart disease is one of the commonest diseases in the western world, with >100.000 deaths a year in the UK. It occurs as a result of a mismatch between the supply and demand of oxygen, usually due to atherosclerosis in one or more of the coronary arteries. The disease is initially asymptomatic because plaques allow sufficient blood flow to match myocardial demand but, as the disease progresses, it can present as angina, acute coronary syndromes and even sudden death. Treatment can be medical or non-medical, including percutaneous coronary intervention and/or coronary artery bypass grafting. With the improvement of percutaneous coronary intervention and stents, indications for surgical intervention are evolving from criteria based merely on angiographic images. Coronary artery bypass surgery provides a safe and effective treatment for a large number of people with coronary artery disease for whom medications and other treatments are unsatisfactory. With overall improvements in technique and perioperative care, patients undergoing this procedure have high prognostic and symptomatic benefit, coupled with a margin of safety.