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Î(Updated in 2014) CABG is generally recommended in preference to PCI
to improve survival in patients with diabetes mellitus and multivessel
CAD for which revascularization is likely to improve survival (3-vessel
CAD or complex 2-vessel CAD involving the proximal LAD), particularly if
a LIMA graft can be anastomosed to the LAD artery, provided the patient
is a good candidate for surgery. (I-B)
Î CABG (I-B) or PCI (I-C) to improve survival is beneficial in survivors of
sudden cardiac death with presumed ischemia-mediated ventricular
tachycardia caused by significant (≥70% diameter) stenosis in a major
coronary artery.
Î (New in 2014) A Heart Team approach to revascularization is
recommended in patients with diabetes mellitus and complex
multivessel CAD. (I-C)
Î CABG to improve survival is reasonable in patients with significant
(≥70% diameter) stenoses in 2 major coronary arteries with severe or
extensive myocardial ischemia (eg, high-risk criteria on stress testing,
abnormal intracoronary hemodynamic evaluation, or >20% perfusion
defect by myocardial perfusion stress imaging) or target vessels
supplying a large area of viable myocardium. (IIa-B)
Î CABG to improve survival is reasonable in patients with mild–
moderate LV systolic dysfunction (EF 35%-50%) and significant
(≥70% diameter stenosis) multivessel CAD or proximal LAD coronary
artery stenosis, when viable myocardium is present in the region of
intended revascularization. (IIa-B)
Î CABG with a left internal mammary artery (LIMA) graft to improve
survival is reasonable in patients with significant (≥70% diameter)
stenosis in the proximal LAD artery and evidence of extensive
ischemia. (IIa-B)
Î It is reasonable to choose CABG over PCI to improve survival 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 The usefulness of CABG to improve survival is uncertain in patients
with significant (70%) diameter stenoses in 2 major coronary arteries
not involving the proximal LAD artery and without extensive ischemia.
(IIb-C)
Î The usefulness of PCI to improve survival is uncertain in patients with
2- or 3-vessel CAD (with or without involvement of the proximal LAD
artery) or 1-vessel proximal LAD disease. (IIb-B)
