CORONARY ARTERY SURGERY: Edited by Marc RuelIt's not all about ISCHEMIA: the case for coronary artery bypass grafting in stable coronary artery diseaseYan, Weianga,b; Eikelboom, Rachela,b; Muller Moran, Hellmuth R.a,b; Arora, Rakesh C.a,b,c Author Information aSection of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine bCardiac Sciences Program cDepartment of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada Correspondence to Rakesh C. Arora, MD, PhD, FRCSC, CR3015 – 369 Taché Avenue, I.H. Asper Institute, St. Boniface Hospital, Winnipeg, Manitoba R2H 2A6, Canada. Tel: +1 204 258 1031; fax: +1 204 231 4624; e-mail: [email protected] Current Opinion in Cardiology: November 2022 - Volume 37 - Issue 6 - p 459-467 doi: 10.1097/HCO.0000000000000994 Buy Metrics Abstract Purpose of Review The recent American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions Guidelines for Coronary Artery Revascularization have raised concerns on the survival benefits of coronary artery bypass grafting (CABG) over guideline-directed medical therapy (GDMT) in stable coronary artery disease (CAD) and appropriate conduit selection for CABG. This review summarizes the evidence supporting CABG for stable CAD and use of the radial artery as a conduit for CABG. Recent Findings CABG has consistently demonstrated a survival benefit over GDMT for patients with stable multivessel CAD. These benefits were more pronounced in patients with diabetes and/or anatomically complex coronary artery disease. The recently published International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial was not designed to and did not include an appropriate patient population to compare revascularization with CABG to GDMT. These results should thus be viewed in the context of previously published studies. Furthermore, increasing evidence suggests that use of a radial artery in CABG is associated with reduced myocardial infarction and repeat revascularization. This should be considered when selecting the appropriate conduits based on underlying patient factors. Summary Readers should be cautious when applying these guidelines broadly. Appropriate consideration of patient and anatomic factors, and in consultation with a multidisciplinary heart team, is important to achieve the best outcomes for patients. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.