Therapy

Offer coronary artery bypass surgery to patients with

• multivessel disease or left main artery disease ^a
• poor left ventricular function ^a
• severe angina ^a
• an abnormal exercise tolerance test  ^a

• Patients with multivessel disease, poor left ventricular function, severe angina or an abnormal exercise test are less likely to die if they have coronary artery bypass surgery. ^a  
• Patients at low risk of dying (1 or 2 vessel disease and ejection fraction > 58%) are more likely to die. ^a

CABG reduces mortality with multivessel disease and poor LV function

Patient a	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
stable coronary artery disease	CABG	medical therapy	death at 10 years	31%	0.83 (0.70 to 0.98)	26 (14 to 230)
stable CAD and abnormal exercise test				17%	0.52 (0.37 to 0.72)	14 (10 to 24)
stable CAD and 3 vessel disease				18%	0.58 (0.42 to 0.80)	15 (11 to 33)
stable CAD and left anterior descending disease				37%	0.32 (0.15 to 0.70)	5 (4 to 13)
stable CAD and normal LV function				13%	0.61 (0.46 to 0.81)	21 (15 to 44)
stable CAD and poor LV function				25%	0.59 (0.39 to 0.91)	12 (7 to 58)
stable CAD and mild angina				13%	0.63 (0.46 to 0.87)	24 (16 to 69)
stable CAD and severe angina				22%	0.57 (0.40 to 0.81)	12 (8 to 29)

CABG reduces mortality in high-risk patients, but increases it in low-risk patients

Patient a	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
unstable angina and 3 vessel disease or ejection fraction < 58%	coronary artery bypass surgery	medical therapy	death at 8 years	35%	32% (1% to 53%)	9 (5 to 140)
unstable angina and 1 or 2 vessel disease and ejection fraction > 58%				17%	-93% (-240% to -3%)	-6 (-33 to -4)

• Patients given CABG compared with angioplasty have less angina, require less anti-anginal medication or revascularisation . There is no clear difference in mortality and myocardial infarction. ^a

Fewer patients with multivessel disease who have a CABG require revascularisation or have further angina.

Patient a	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
multivessel coronary artery disease	CABG	angioplasty	angina-free at 3 years	75%	1.57 (1.32 to 1.87)	13 (10 to 20)
			CABG at 3 years	20%	0.04 (0.02 to 0.07)	5 (3 to 6)
			angioplasty at 3 years	23%	0.21 (0.16 to 0.27)	5 (5 to 6)

ABG reduces mortality in high-risk patients, but increases it in low-risk patients

Patient a	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
unstable angina and 3 vessel disease or ejection fraction < 58%	coronary artery bypass surgery	medical therapy	death at 8 years	35%	32% (1% to 53%)	9 (5 to 140)
unstable angina and 1 or 2 vessel disease and ejection fraction > 58%				17%	-93% (-240% to -3%)	-6 (-33 to -4)