[Indications for coronary dilatation and bypass surgery]

Coronary artery disease is the dominant disorder in industrialized countries. It can be treated by drugs, coronary angioplasty, or bypass surgery. Angioplasty has become the most frequent mode of active therapy. Local variations in the use of treatment modalities can be explained mainly by early detection of coronary artery disease yielding more candidates for angioplasty. All indications should be based on a combination of symptoms, objective signs of ischemia (e.g., stress test) and angiographic correlates. Coronary angioplasty is limited to the less complex cases such as single vessel disease (except for diffuse disease, old total occlusions), double vessel disease with up to 3 discrete lesions or lesions in secondary vessels, and, exceptionally, triple vessel disease of the appropriate kind (usually in 2 sessions). These limitations arise from the drawbacks of the method, i.e., acute occlusion (about 7%), recurrence (about 30%), and technical failures (about 5%). For acute myocardial infarction, direct coronary angioplasty is probably the method of choice, provided it can be performed within 30 minutes after diagnosis. For unstable angina, the results are inferior to those obtained with stable symptomatology; compared with the spontaneous prognosis, they remain nonetheless beneficial. The same holds true for angioplasty in elderly patients, where the reduced chances of success must be viewed in light of a typically very severe clinical picture. Angioplasty is often a blessing for young patients. It allows immediate resumption of a normal life and is easily repeatable over the years. Indications for coronary bypass surgery should not be deduced from the randomized studies of the seventies. They concentrated on survival, and surgical methods have been refined since.(ABSTRACT TRUNCATED AT 250 WORDS)