The following patients are best treated with coronary artery bypass grafting (CABG):

B. A 60-year-old man with unstable angina, three-vessel disease, and an ejection fraction of 35%.

D. A 60-year-old man with diabetes, class IV angina, 75% proximal left anterior descending and 75% proximal right coronary artery obstruction, and left ventricular ejection fraction of 60%.

DISCUSSION: CABG has been shown to prolong patient survival compared with medical therapy in those patients with left main occlusive disease and those with three-vessel or two-vessel disease with proximal left anterior descending involvement in association with class III or greater anginal symptoms, impaired ejection fraction, or easily inducible ischemia with exercise. Although percutaneous transluminal coronary angioplasty (PTCA) appears to be comparable to CABG in nondiabetic patients, patients with diabetes appear to have a significant survival advantage when CABG is used. Similarly, patients with more extensive coronary artery disease are better treated with CABG than with PTCA.