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5.2. Revascularization: PCI Versus CABG
COR LOE
Recommendations
Patients With CCD
1 B-R 1. In patients with CCD who require revascularization for
significant left main involvement associated with high-
complexity CAD, CABG is recommended in preference to
PCI to improve survival.*
2a B-R 2. In patients with CCD who require revascularization for
multivessel CAD with complex and diffuse CAD (eg,
SYNTAX score >33), it is reasonable to choose CABG over
PCI to improve survival.*
Patients With CCD at High Surgical Risk
2a B-NR 3. In patients with CCD who are appropriate for
revascularization but poor candidates for surgery, it is
reasonable to choose PCI over CABG to improve symptoms
and reduce MACE.
Patients With CCD and Diabetes
1 A 4. In patients with CCD, diabetes, and multivessel CAD with
involvement of the left anterior descending artery who
are appropriate candidates for CABG, CABG (with a left
internal mammary artery to the left anterior descending
artery) is recommended in preference to PCI to reduce
mortality and repeat revascularizations.*
2b B-R 5. In patients with CCD and diabetes who have left main
stenosis and low- or intermediate-complexity CAD (eg,
SYNTAX score ≤33), PCI may be considered as an alternative
to CABG to reduce MACE.*
* Modified from the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization.
Lawton JS, et al. op. cit.
