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Stable Ischemic Heart Disease

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35 Î TMR performed as an adjunct to CABG to improve symptoms may be reasonable in patients with viable ischemic myocardium that is perfused by arteries that are not amenable to grafting. (IIb-B) Î CABG or PCI to improve symptoms should NOT be performed in patients who do not meet anatomic (≥50% diameter left main or ≥70% non-left main stenosis diameter) or physiological (eg, abnormal FFR) criteria for revascularization. (III-C: Harm) Dual Antiplatelet Therapy (DAPT) Compliance and Stent Thrombosis Î PCI with coronary stenting (bare-metal stent [BMS] or drug-eluting stent [DES]) should NOT be performed if the patient is not likely to be able to tolerate and comply with DAPT for the appropriate duration of treatment based on the type of stent implanted. (III-B: Harm) Hybrid Coronary Revascularization Î Hybrid coronary revascularization (defined as the planned combination of LIMA-to-LAD artery grafting and PCI of ≥1 non-LAD coronary arteries) is reasonable in patients with one or more of the following (IIa-B): • Limitations to traditional CABG, such as heavily calcified proximal aorta or poor target vessels for CABG (but amenable to PCI) • Lack of suitable graft conduits • Unfavorable LAD artery for PCI (ie, excessive vessel tortuosity or chronic total occlusion). Î Hybrid coronary revascularization may be reasonable as an alternative to multivessel PCI or CABG in an attempt to improve the overall risk- benefit ratio of the procedures. (IIb-C)

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