Coronary Artery Bypass Grafting in the Era of Evidence-Based Medicine

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, necessitating evidence-based treatment strategies to optimize patient outcomes 1,2) .Clinical guidelines established by major cardiovascular societies, including the European Society of Cardiology (ESC), the European Association for Cardiothoracic Surgery (EACTS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Japanese Circulation Society (JCS), provide structured recommendations for the management of CAD [1][2][3] .These guidelines primarily focus on the selection of coronary revascularization strategies, particularly coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), in conjunction with optimal medical therapy (OMT).Despite the shared goal of improving cardiovascular outcomes, significant differences exist among these guidelines in their recommendations regarding revascularization, risk stratification, and the role of the multidisciplinary heart team in decision-making.In recent years, pivotal clinical trials, such as the ISCHEMIA and FREEDOM trials, have influenced guideline revisions, shifting emphasis toward a more selective approach to revascularization [4][5][6] .Consequently, CABG, once widely recommended for multivessel disease, has seen a relative downgrading in certain patient subsets, leading to ongoing debate regarding its optimal role in contemporary practice.This review examines the evolving landscape of CABG in current clinical guidelines, critically analyzing recent updates, and the impact of major trials on treatment recommendations.In addition, advancements in surgical techniques, including arterial graft selection, off-pump CABG, minimally invasive approaches,