25
Patients With Diabetes
COR LOE
Recommendations
1 A 1. In patients with diabetes and multivessel CAD with the
involvement of the LAD, who are appropriate candidates for
CABG, CABG (with a LIMA to the LAD) is recommended
in preference to PCI to reduce mortality and repeat
revascularizations.
2a B-NR 2. In patients with diabetes who have multivessel CAD amenable
to PCI and an indication for revascularization and are poor
candidates for surgery, PCI can be useful to reduce long-term
ischemic outcomes.
2b B-R 3. In patients with diabetes who have left main stenosis and low-
or intermediate-complexity CAD in the rest of the coronary
anatomy, PCI may be considered an alternative to CABG to
reduce major adverse cardiovascular outcomes.
Patients With Previous CABG
COR LOE
Recommendations
2a B-NR 1. In patients with previous CABG with a patent LIMA to the
LAD who need repeat revascularization, if PCI is feasible, it is
reasonable to choose PCI over CABG.
2a C-LD 2. In patients with previous CABG and refractory angina on
GDMT that is attributable to LAD disease, it is reasonable
to choose CABG over PCI when an IMA can be used as a
conduit to the LAD.
2b B-NR 3. In patients with previous CABG and complex CAD, it may
be reasonable to choose CABG over PCI when an IMA can
be used as a conduit to the LAD.
DAPT Adherence
COR LOE
Recommendation
2a B-NR 1. In patients with multivessel CAD amenable to treatment with
either PCI or CABG who are unable to access, tolerate, or
adhere to DAPT for the appropriate duration of treatment,
CABG is reasonable in preference to PCI.
