ACC GUIDELINES Bundle (free trial)

Stable Ischemic Heart Disease

ACC GUIDELINES Apps brought to you courtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/244045

Contents of this Issue

Navigation

Page 35 of 45

34 Treatment Î CABG might be considered with the primary or sole intent of improving survival in patients with SIHD with severe LV systolic dysfunction (EF <35%) whether or not viable myocardium is present. (IIb-B) Î The usefulness of CABG or PCI to improve survival is uncertain in patients with previous CABG and extensive anterior wall ischemia on noninvasive testing. (IIb-B) Î CABG or PCI should NOT be performed with the primary or sole intent to improve survival in patients with SIHD with one or more coronary stenoses that are not anatomically or functionally significant (eg, <70% diameter non-left main coronary artery stenosis, fractional flow reserve (FFR) >0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. (III-B Harm) Revascularization to Improve Symptoms Î CABG or PCI to improve symptoms is beneficial in patients with one or more significant (≥70% diameter) coronary artery stenoses amenable to revascularization and unacceptable angina despite GDMT. (I-A) Î CABG or PCI to improve symptoms is reasonable in patients with one or more significant (≥70% diameter) coronary artery stenoses and unacceptable angina for whom GDMT cannot be implemented because of medication contraindications, adverse effects, or patient preferences. (IIa-C) Î PCI to improve symptoms is reasonable in patients with previous CABG, one or more significant (≥70% diameter) coronary artery stenoses associated with ischemia, and unacceptable angina despite GDMT. (IIa-C) Î It is reasonable to choose CABG over PCI to improve symptoms in patients with complex 3-vessel CAD (eg, SYNTAX score >22), with or without involvement of the proximal LAD artery, who are good candidates for CABG. (IIa-B) Î CABG to improve symptoms might be reasonable for patients with previous CABG, one or more significant (≥70% diameter) coronary artery stenoses not amenable to PCI, and unacceptable angina despite GDMT. (IIb-C)

Articles in this issue

Archives of this issue

view archives of ACC GUIDELINES Bundle (free trial) - Stable Ischemic Heart Disease