20
Treatment
Revascularization to Improve Survival in SIHD Compared
With Medical Therapy
COR LOE
Recommendations
Le ventricular dysfunction and multivessel CAD
1 B-R 1. In patients with SIHD and multivessel CAD appropriate for
CABG with severe left ventricular systolic dysfunction (left
ventricular ejection fraction <35%), CABG is recommended
to improve survival.
2a B-NR 2. In selected patients with SIHD and multivessel CAD
appropriate for CABG and mild-to-moderate left ventricular
systolic dysfunction (ejection fraction 35%–50%), CABG (to
include a LIMA graft to the LAD) is reasonable to improve
survival.
Le main CAD
1 B-R 3. In patients with SIHD and significant left main stenosis,
CABG is recommended to improve survival.
2a B-NR 4. In selected patients with SIHD and significant left
main stenosis for whom PCI can provide equivalent
revascularization to that possible with CABG, PCI is
reasonable to improve survival.
Multivessel CAD
2b B-R 5. In patients with SIHD, normal ejection fraction, significant
stenosis in 3 major coronary arteries (with or without
proximal LAD), and anatomy suitable for CABG, CABG
may be reasonable to improve survival.
2b B-R 6. In patients with SIHD, normal ejection fraction, significant
stenosis in 3 major coronary arteries (with or without
proximal LAD), and anatomy suitable for PCI, the usefulness
of PCI to improve survival is uncertain.
Stenosis in the proximal LAD artery
2b B-R 7. In patients with SIHD, normal left ventricular ejection
fraction, and significant stenosis in the proximal LAD, the
usefulness of coronary revascularization to improve survival
is uncertain.
Revascularization in SIHD
