The results of the European Study apply to the patients who met the inclusion criteria of this study: men, aged under 65, with angina pectoris of more than three months' duration, 50% or greater intraluminal diameter narrowing in at least two major coronary arteries and good left ventricular function (ejection fraction greater than or equal to 50%). The results imply that prophylactic coronary bypass surgery should be considered only for those patients with angina who are at risk of premature death defined by the non-invasive prognostic predictors (ischemic abnormalities in the resting ECG, marked ST-depression during exercise, peripheral arterial disease, age) and the extent and size of coronary obstructions. The severity of angina is of limited relevance in this context. The patients in a low risk phase of the disease do not require surgery unless they have unacceptable symptoms in spite of adequate medical treatment. No evidence emerges to support the assumption that coronary bypass surgery protects against future myocardial infarction. Although surgery relieves angina pectoris and improves physical performance, it does not significantly delay retirement from work over a period of five years.
