TY - CHAP M1 - Book, Section TI - Primary Coronary Artery Bypass Surgery A1 - Rushing, G.D. A1 - Yuh, David D. A2 - Yuh, David D. A2 - Vricella, Luca A. A2 - Yang, Stephen C. A2 - Doty, John R. PY - 2014 T2 - Johns Hopkins Textbook of Cardiothoracic Surgery AB - EpidemiologyAffecting more than 1.5 million Americans annually, coronary artery disease is the most common form of heart disease, and its complications are the leading cause of death in both men and women.PathophysiologyCoronary artery disease is generally caused by atherosclerotic luminal narrowing, resulting in insufficient coronary blood flow to the myocardium. The process consists of subintimal atheroma deposition, leading to arterial luminal stenosis or occlusion and wall thickening.Clinical featuresTypically, significant coronary atherosclerosis becomes manifest as angina, but it can also present with anginal-equivalent symptoms, including dyspnea, dizziness, syncope, and pulmonary edema. Malignant coronary disease leading to ischemic cardiomyopathy is associated with congestive symptoms. Identified factors that contribute to severe atherosclerotic coronary artery disease include obesity, hypercholesterolemia, obesity, diabetes, tobacco use, and sedentary lifestyle.DiagnosticsTwelve-lead electrocardiography is initially used to diagnose myocardial ischemia. Further investigation consists of exercise stress testing, evaluation of myocardial enzymes (i.e., CPK-MB, troponin), echocardiography, and coronary angiography.TreatmentInitial medical management of acute myocardial ischemia consists of beta blockade, nitrates, anti-platelet therapy, and supplemental oxygen. After precise delineation of coronary arteriopathy, definitive treatment consists of coronary artery bypass grafting (CABG) or percutaneous angioplasty and stenting.Outcomes/prognosisCABG carries an overall mortality of about 3 percent; elective primary coronary bypass carries a mortality rate of approximately 1.7 percent. Complications associated with CABG include renal failure, neurologic injury, heart failure, hemorrhage, respiratory failure, and renal dysfunction. Overall, CABG achieves excellent outcomes with respect to anginal relief and resumption of normal activities. In general, completeness and durability of revascularization is superior with surgical revascularization versus percutaneous interventions. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/15 UR - accesssurgery.mhmedical.com/content.aspx?aid=1104588826 ER -