For several decades, the anatomic degree of coronary artery stenosis (CAS) has been the sole criterion for determining target vessels for coronary revascularization. There have been many studies evaluating the impact of functional ischemia-based revascularization during percutaneous coronary intervention. However, only limited data are available for this issue in the surgical setting. Nowadays, there has been growing interest regarding the impact of the functional significance of CAS on the results after surgical revascularization. Therefore, in this narrative review, the benefits and shortcomings of functional ischemia-guided coronary artery bypass grafting (CABG) are summarized, and available literature evaluating the impact of functional ischemia-guided CABG on clinical and angiographic outcomes are reviewed.Because only limited data have been published for this issue, future studies with large patient cohort might be needed to draw definite conclusions.

Spinal cord infarction is an uncommon form of spinal cord injury, and the diversity of its symptoms makes timely diagnosis difficult. Here, we present a case of spinal cord infarction mistaken for acute coronary syndrome (ACS) at initial evaluation. An 85-year-old man presented at the emergency department with chest pain. Initial electrocardiogram showed T-wave inversion, poor R-wave progression, and slightly elevated cardiac marker levels.Coronary angiography showed an intermediate lesion in the anterior descending artery, and percutaneous coronary intervention was deferred based on the fractional flow reserve results.After admission, the patient complained of voiding difficulties and progressive weakness in the lower extremities. Magnetic resonance imaging showed multifocal spinal cord infarction from T5 to T7. Although the initial clinical presentation of spinal cord infarction is similar to an ACS, the neurologic deficits and imaging studies help to distinguish it.