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Revascularization
5.1. Revascularization
COR LOE
Recommendations
Goals of Revascularization
1 A 1. In patients with CCD and lifestyle-limiting angina
despite GDMT and with significant coronary artery
stenoses amenable to revascularization, revascularization is
recommended to improve symptoms.*
1 B-R 2. In patients with CCD who have significant left main
disease or multivessel disease with severe LV dysfunction
(LVEF ≤ 35%), CABG in addition to medical therapy
is recommended over medical therapy alone to improve
survival.*
Cost Value
Statement:
Intermediate
Value
B-NR 3. In patients with CCD and multivessel disease with severe
LV dysfunction, CABG added to optimal medical therapy
is of intermediate economic value compared with medical
therapy alone.
2a B-R 4. In patients with CCD and multivessel CAD appropriate
for either CABG or PCI, revascularization in addition to
GDMT is reasonable to lower the risk of cardiovascular
events such as spontaneous MI, unplanned urgent
revascularizations, or cardiac death.*
2a B-NR 5. In selected patients with CCD and significant left
main stenosis for whom PCI can provide equivalent
revascularization to that possible with CABG, PCI is
reasonable to improve survival.*
Decision-Making for Revascularization
1 A 6. In patients with CCD who have angina or an anginal
equivalent, no previous evaluation for ischemia, and
angiographically intermediate stenoses, the use of FFR or
other proven nonhyperemic pressure ratios (eg, iFR) is
recommended before proceeding with PCI.*
Cost Value
Statement:
High Value
B-NR 7. In patients with CCD undergoing coronary angiography
without previous stress testing, the use of invasive FFR to
evaluate angiographically intermediate coronary stenoses
before proceeding with PCI is a high economic value
intervention.
1 B-NR 8. In patients with CCD with complex 3-vessel disease
or for whom the optimal treatment strateg y is unclear,
a Heart Team approach that includes representatives
from interventional cardiolog y and cardiac surgery is
recommended to improve patient outcomes.*
* Modified from the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization.
Lawton JS, et al. op. cit.
5. Revascularization
