Coronary artery surgery: the use of decision analysis

The choice between coronary by-pass surgery and medical therapy in patients with angiographically documented coronary artery disease was examined. This decision analysis included consideration of patient preferences, severity of disease, prognosis with medical therapy, surgical mortality rate, graft patency rate, the probability that surgery will provide both short-term and long-term pain relief, and the probability that surgery will alter long-term survival. Coronary surgery was found to be the preferred therapy in many patients with disabling angina; it was rarely found to be the preferred therapy in asymptomatic patients, even those with proximal obstruction of the left anterior descending coronary artery. The therapeutic decision was strongly affected by differences in patient attitudes and differences in the past results of the prospective surgeon. This paper presents both a data base and a methodology that allow the physician to apply decision analysis to individual patients with coronary artery disease.