Treatment
Coronary Revascularization With PCI and CABG in Patients
With UA/NSTEMI
Tables 8 and 9 are excerpted from the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary
Intervention (Circulation: http://circ.ahajournals.org/content/124/23/e574.full;
JACC: http://content.onlinejacc.org/article.aspx?articleid=1147816) and 2011 ACCF/AHA
Guideline for Coronary Artery Bypass Graft Surgery (Circulation: http://circ.ahajournals.org/
content/124/23/e652.full; JACC: http://content.onlinejacc.org/article.aspx?articleid=1147818) and
are included to provide a comprehensive and concordant set of recommendations for revascularization.
See the respective guidelines for supportive references and supplemental text.
ÎÎThe selection of PCI or CABG as the means of revascularization
in the patient with ACS should generally be based on the same
considerations as those without ACS. (I-B)
Table 8. Revascularization to Improve Survival Compared
with Medical Therapy
Anatomic Setting
COR
Unprotected left main (UPLM) or complex CAD
CABG and PCI
I—Heart Team approach recommended
CABG and PCI
IIa—Calculation of STS and SYNTAX scores
UPLM*
CABG
I
PCI
IIa—For SIHD when both of the following are present:
• Anatomic conditions associated with a low risk of
PCI procedural complications and a high likelihood
of good long-term outcome (eg, a low SYNTAX
score of ≤22, ostial or trunk left main CAD)
• Clinical characteristics that predict a significantly
increased risk of adverse surgical outcomes (eg,
STS-predicted risk of operative mortality ≥5%)
IIa—For UA/NSTEMI if not a CABG candidate
IIa—For STEMI when distal coronary flow is TIMI
flow grade <3 and PCI can be performed more
rapidly and safely than CABG
IIb—For SIHD when both of the following are present:
• Anatomic conditions associated with a low to
intermediate risk of PCI procedural complications
and an intermediate to high likelihood of good longterm outcome (eg, low-intermediate SYNTAX score
of <33, bifurcation left main CAD)
• Clinical characteristics that predict an increased risk
of adverse surgical outcomes (eg, moderate-severe
COPD, disability from prior stroke, or prior cardiac
surgery; STS-predicted operative mortality >2%)
III: Harm—For SIHD in patients (versus performing
CABG) with unfavorable anatomy for PCI and
who are good candidates for CABG
30
LOE
C
B
B
B
B
C
B
B
