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Î TMR performed as an adjunct to CABG to improve symptoms may
be reasonable in patients with viable ischemic myocardium that is
perfused by arteries that are not amenable to grafting. (IIb-B)
Î CABG or PCI to improve symptoms should NOT be performed in
patients who do not meet anatomic (≥50% diameter left main or
≥70% non-left main stenosis diameter) or physiological (eg, abnormal
FFR) criteria for revascularization. (III-C: Harm)
Dual Antiplatelet Therapy (DAPT) Compliance and Stent
Thrombosis
Î PCI with coronary stenting (bare-metal stent [BMS] or drug-eluting
stent [DES]) should NOT be performed if the patient is not likely to be
able to tolerate and comply with DAPT for the appropriate duration of
treatment based on the type of stent implanted. (III-B: Harm)
Hybrid Coronary Revascularization
Î Hybrid coronary revascularization (defined as the planned combination
of LIMA-to-LAD artery grafting and PCI of ≥1 non-LAD coronary
arteries) is reasonable in patients with one or more of the following
(IIa-B):
• Limitations to traditional CABG, such as heavily calcified proximal aorta or poor
target vessels for CABG (but amenable to PCI)
• Lack of suitable graft conduits
• Unfavorable LAD artery for PCI (ie, excessive vessel tortuosity or chronic total
occlusion).
Î Hybrid coronary revascularization may be reasonable as an alternative
to multivessel PCI or CABG in an attempt to improve the overall risk-
benefit ratio of the procedures. (IIb-C)
