Chronic stable angina revascularization with PCI and CABG in asymptomatic patients

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; ; Associate Editors-In-Chief: John Fani Srour, M.D.; Smita Kohli, M.D.

==ACC/AHA Guidelines- Recommendations for Revascularization with PCI and CABG in Asymptomatic Patients (DO NOT EDIT) == {{cquote|

Class I
1. CABG for patients with significant left main coronary disease. (Level of Evidence: B)

2. CABG for patients with three-vessel disease. The survival benefit is greater in patients with abnormal LV function (ejection fraction less than 50%). (Level of Evidence: C)

3. CABG for patients with two-vessel disease with significant proximal left anterior descending CAD and either abnormal LV function (ejection fraction less than 50%) or demonstrable ischemia on noninvasive testing. (Level of Evidence: C)

4. PCI for patients with two- or three-vessel disease with significant proximal Left anterior descending CAD who have anatomy suitable for catheter based therapy and normal LV function and who do not have treated diabetes. (Level of Evidence: C)

5. PCI or CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD but with a large area of viable myocardium and high-risk criteria on non-invasive testing. (Level of Evidence: C)

6. CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD who have survived sudden cardiac death or sustained ventricular tachycardia. (Level of Evidence: C)

7. In patients with prior PCI, CABG or PCI for recurrent stenosis associated with a large area of viable myocardium or high-risk criteria on noninvasive testing. (Level of Evidence: C)

Class IIa
1. PCI or CABG for patients with one-vessel disease with significant proximal left anterior descending CAD. (Level of Evidence: C)

Class IIb
1. Compared with CABG, PCI for patients with two or three vessel disease with significant proximal left anterior descending CAD who have anatomy suitable for catheter-based therapy and who have treated diabetes or abnormal LV function. (Level of Evidence: B)

2. Use of PCI for patients with significant left main coronary disease who are not candidates for CABG. (Level of Evidence: C)

3. PCI for patients with one or two-vessel CAD without significant proximal left anterior descending CAD who have survived sudden cardiac death or sustained ventricular tachycardia. (Level of Evidence: C)

4. Repeat CABG for patients with multiple saphenous vein graft stenoses, with high-risk criteria on noninvasive testing, especially when there is significant stenosis of a graft supplying the LAD. PCI may be appropriate for focal saphenous vein graft lesions or multiple stenoses in poor candidates for reoperative surgery. (Level of Evidence: C)

5. PCI or CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD but with a moderate area of viable myocardium and demonstrable ischemia on noninvasive testing. (Level of Evidence: C)

Class III
1. Use of PCI or CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD and
 * a. only a small area of viable myocardium or
 * b. no demonstrable ischemia on noninvasive testing. (Level of Evidence: C)

2. Use of PCI or CABG for patients with borderline coronary stenoses (50% to 60% diameter in locations other than the left main coronary artery) and no demonstrable ischemia on noninvasive testing. (Level of Evidence: C)

3. Use of PCI or CABG for patients with insignificant coronary stenosis (less than 50% diameter). (Level of Evidence: C)

4. Use of PCI in patients with significant left main CAD who are candidates for CABG. (Level of Evidence: B)}}

Guidelines Resources

 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina