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November 1979

Coronary Artery Bypass SurgeryAnother View

Arch Intern Med. 1979;139(11):1220-1222. doi:10.1001/archinte.1979.03630480010006

Scientific establishment of the overall role of coronary artery bypass surgery in the management of patients with coronary disease is probably one of the most pressing issues in medicine in the United States today. It inherently embodies major medical, social, and economic implications. Controversy continues to abound in many areas concerning indications, contraindications, accuracy of diagnosis, mortality, morbidity, importance of patient age, relief of symptoms, improvement in measured physical performance, effect on sudden death, prolongation of longevity, hemodynamic change, amelioration of congestive heart failure, effect on rhythm disturbances, importance of collaterals, graft patency, return of symptoms, myocardial infarction rate, mechanisms of action, and patient rehabilitation potential and cost-effectiveness. Strong stances are taken by experts ranging from the ultraconservative to the ultra-aggressive ends of the spectrum. Working through this maze of conflicts becomes a difficult task for the physician seeking to advise his patients in good conscience. No difficulty lies with

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