In Reply Drs Civeira and Mateo-Gallego question the referral of a stable patient for CABG surgery. The patient we described had severe myocardial ischemia and more than 70% obstructive disease in all 3 coronary arteries—findings that provide a class I indication for CABG surgery to improve survival.1 Results from trials such as COURAGE and FAME 2 (Fractional Flow Reserve vs Angiography for Multivessel Evaluation 2) demonstrate that many patients with stable ischemic heart disease can be treated with optimal medical therapy alone but do not fully address how to manage the care of patients with severe ischemia.2,3
Polonsky TS, Blankstein R. Treatment of Patients With Stable Ischemic Heart Disease—Reply. JAMA. 2016;315(17):1906–1907. doi:10.1001/jama.2016.0695
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