Guidelines of the Spanish Society of Cardiology for Coronary Artery Disease Surgery

Surgery in coronary disease, including myocardial revascularization and the surgery of mechanical complications of acute myocardial infarction, has sh own to improve the symptoms, quality of life and/or prognosis in certain gr oups of patients. The expected benefit in each patient depend on many well- known factors among which the appropriateness of the indication for surgery is fundamental. The objective of these guidelines is to review current indications for card iac surgery in patients with coronary heart disease through an evaluation o f the degree of evidence of effectiveness in the light of current knowledge (systematic review of bibliography) and expert opinion gathered from vario us reports. Indications and the degree of recommendation for conventional coronary arte ry bypass grafting have been established for each of the most frequent anat omo-clinical situations defined by clinical symptoms (stable angina, unstab le angina and acute myocardial infarction) as well as by left ventricular f unction and extend of coronary disease. Furthermore, the subgroups with the greatest surgical risk and stratification models are described to aid the decision making process. Also we analyse the rational basis and indication for the new surgical techniques such as minimally invasive coronary surgery and total arterial revascularization. Finally, the indication and timing o f surgery in patients with mechanical complications of acute myocardial inf arction are considered.