Indications for Coronary Artery Bypass Graft (CABG)

Helpful Highlights

• Coronary artery disease (CAD), or heart disease, is the origin of most heart attacks.

• Bypass surgery (CABG) is performed to prevent a heart attack, resolve an active heart attack, or foster better outcomes and quality of life after a heart attack.

• Symptoms of CAD are like those of a heart attack, though often milder, with a couple of unique symptoms, as well.

A cardiologist may recommend a coronary artery bypass graft (CABG) to lower the risk of a heart attack in the face of severe coronary artery disease (CAD) - in other words, before a heart attack ever happens. A CABG is also performed, of course, in an emergency to treat a severe heart attack that is a threat to life. CABG also may be used to treat people who have heart damage after a heart attack and still have blocked arteries.

Symptoms of coronary artery disease (CAD)

• Chest pain (called angina)

• Frequent or persistent fatigue, maybe weakness

• Faster than normal heartbeat at rest (normal is 60-100 beats per minute) 

• An irregular heartbeat (called arrhythmia)

• Shortness of breath, usually with activity and not at rest

• Swelling in the hands, feet/ankles, or even face

• Frequent or persistent indigestion (heartburn, acid reflux)

• Lightheadedness, maybe nausea

When CABG may be recommended

• Other treatments, such as lifestyle changes (diet, exercise, habits) and/or medications haven't worked.

• There are blockages in the heart that can't be treated with angioplasty (balloon or stent)

• There are significant to severe blockages (> 70%) in one or more of the three large coronary arteries* that supply a major part of the heart muscle with blood, especially if the heart's pumping action is already weakened

*Left anterior descending artery and circumflex artery (that make up the left main coronary artery), and the right main coronary artery

Candidacy for CABG is based on several factors

• The presence and severity of CAD symptoms

• The severity and location of blockages in the coronary arteries

• History and past treatment of heart disease, including surgeries, procedures, and medications

• Response to other treatments

• History of other medical problems, diseases, and conditions (called comorbidities)

• Current quality of life

• Age and general health and well-being

• Family history of heart disease, heart attack, or other heart conditions

The goals of CABG

• Improve survival odds

• Improve the quality of life and decrease angina and other symptoms of CAD

• Resume a more active lifestyle

• Improve the pumping action of the heart

• Lower the chances of an initial heart attack or second heart attack