31
Table 12. Revascularization to Improve Survival Compared
with Medical Therapy (continued)
Anatomic Setting COR LOE
1-vessel proximal LAD artery disease
CABG IIa—With LIMA for long-term benefit B
PCI IIb—Of uncertain benefit B
1-vessel disease without proximal LAD artery involvement
CABG III: Harm B
PCI III: Harm B
LV dysfunction
CABG IIa—EF 35%-50% B
CABG IIb—EF <35% without significant le main CAD B
PCI Insufficient data
Survivors of sudden cardiac death with presumed ischemia-mediated VT
CABG I B
PCI I C
No anatomic or physiological criteria for revascularization
CABG III: Harm B
PCI III: Harm B
* CABG (particularly with LIMA gra to LAD) is generally recommended in preference to PCI
to improve survival in patients with diabetes mellitus and 3-vessel CAD or complex 2-vessel CAD
involving the proximal LAD (I-B).
Table 13. Revascularization to Improve Symptoms With
Significant Anatomic (≥50% Left Main or ≥70%
Non–Left Main CAD) or Physiological (Fractional
Flow Reserve [FFR] ≤0.80) Coronary Artery Stenoses
Clinical Setting COR LOE
≥1 significant stenosis amenable to revascularization and
unacceptable angina despite GDMT
I—CABG A
I—PCI
≥1 significant stenoses and unacceptable angina in whom
GDMT cannot be implemented because of medication
contraindications, adverse effects, or patient preferences
IIa—CABG C
IIa—PCI C
Previous CABG with ≥1 significant stenoses associated
with ischemia and unacceptable angina despite GDMT
IIa—PCI C
IIb—CABG C
Complex 3-vessel CAD (eg, SYNTAX score >22) with
or without involvement of the proximal LAD artery and
a good candidate for CABG
IIa—CABG
preferred
over PCI
B
Viable ischemic myocardium that is perfused by
coronary arteries that are not amenable to grafting
IIb—TMR as an
adjunct to
CABG
B
No anatomic or physiological criteria for
revascularization
III: Harm—CABG C
III: Harm—PCI C
