Aorto-coronary-vein bypass, a new surgical technique to revascularize the myocardium, is being enthusiastically received by most cardiologists as a major breakthrough in the conquest of the nation's number-one killer, but with skepticism by others. Although some 20,000 of these operations have been performed in the past 12 months, we still do not know even the first fact—whether vein bypass increases survival. By appearing to lessen angina it might improve the quality of life, but unless registries are soon established to study survival and results in each case, we will not be able to establish indications, contraindications, and constraints for the new revascularization procedures.
We already know that one year after revascularization about 22% of vein grafts are occluded, 18% of patients have sustained a myocardial infarction, and cardiac function is worsened in 50% of those with previous myocardial damage. Long-range studies have provided the natural history of anginal patients and