Which scenario indicates an indication for CABG after medical therapy failure or disease progression?

• A. Shortness of breath with no angina
• B. Unstable angina not controlled with meds
• C. Elective cosmetic surgery
• D. Stable angina controlled with meds

Answer: (B)

When ischemia persists despite optimized medical therapy, revascularization becomes indicated. Unstable angina—chest pain at rest or with increasing frequency that remains uncontrolled by antianginal medications and standard medical therapy—signals that medical management has failed to control the underlying ischemia. In this scenario, CABG is pursued to restore blood flow and stabilize the patient, especially when anatomy suggests extensive disease (such as multivessel or left main involvement) where surgical revascularization offers the best outcomes.

In contrast, shortness of breath without angina may reflect nonischemic causes or non-urgent issues; stable angina controlled with meds indicates adequate symptom control without an urgent need for revascularization; elective cosmetic surgery is unrelated to ischemic burden and does not indicate CABG.