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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)
