Are bypass operations a big scam?

My jaw dropped when I read about this study below in the New England Journal
of Medicine (hardly some quack alternative medicine resource). Is this 1984
CASS study still authoritative or has it been debunked? From what I gather,
bypass operations HAVE been shown to be effective in the small minority of
patients who have a left main coronary artery blockage, but otherwise not.

What does this mean- if the cardiologist tells you that you need a bypass
operation and you don't have the left main artery blockage, should you
assume he's trying to scam you? Are there any other valid reasons to get a
bypass?

TIA,

Robert

N Engl J Med. 1984 Mar 22;310(12):750-8.


Myocardial infarction and mortality in the coronary artery surgery study
(CASS) randomized trial.

[No authors listed]

The long-term benefit of coronary bypass surgery in terms of longevity and
prevention of major ischemic events in patients who have mild angina is not
well defined. The randomized Coronary Artery Surgery Study (CASS) was
designed to evaluate this issue; it consists of 780 patients who were
considered operable and who had mild stable angina pectoris or who were free
of angina after infarction. As a result of the randomization process there
were no significant differences in base-line variables between patients
randomly assigned to medical and to surgical therapy. The likelihood of
death in the five-year period after randomization was only 8 per cent in the
medical cohort, as compared with 5 per cent in the surgical cohort (not
significant). The likelihood of nonfatal Q-wave myocardial infarction was 11
and 14 per cent, respectively (not significant). The five-year probability
of remaining alive and free of infarction was 82 per cent in the patients
assigned to medical therapy and 83 per cent in the patients assigned to
surgery (not significant). There were no statistically significant
differences in the survival rate or in the myocardial-infarction rate
between subgroups of patients randomly assigned to medical and to surgical t
herapy when they were analyzed according to initial group assignment, number
of diseased vessels, or ejection fraction. Therefore, as compared with
medical therapy, coronary bypass surgery appears neither to prolong life nor
to prevent myocardial infarction in patients who have mild angina or who are
asymptomatic after infarction in the five-year period after coronary
angiography,




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