American Board of Internal Medicine (ABIM) Certification Practice Exam

Coronary artery bypass grafting is recommended for patients with what specific condition?

1. Single vessel disease with stable angina

2. Left main disease or multivessel disease with certain conditions

3. Uncontrolled hypertension

4. Aortic stenosis

The correct answer is: Left main disease or multivessel disease with certain conditions

Coronary artery bypass grafting (CABG) is particularly recommended for patients with left main coronary artery disease or multivessel coronary artery disease, especially when there are specific clinical conditions present, such as significant ischemia or reduced left ventricular function. In the case of left main disease, the blockage significantly affects blood flow to the heart muscle, and bypass surgery can effectively restore this flow, reducing the risk of heart attacks and improving survival rates. Multivessel disease can also lead to considerable risk if multiple coronary arteries are narrowed, often requiring surgical intervention if the patient presents with severe symptoms, reduced functional capacity, or is not a candidate for percutaneous coronary intervention (PCI). For other conditions listed, such as single vessel disease with stable angina, uncontrolled hypertension, and aortic stenosis, the indications for CABG are not straightforward. Single vessel disease can often be managed with less invasive procedures, uncontrolled hypertension typically requires medical management, and aortic stenosis necessitates valve intervention rather than bypass surgery. Therefore, CABG's role is critical primarily in cases involving left main or multivessel disease associated with specific symptoms or conditions that jeopardize the patient's cardiac health.