Chronic stable angina guidelines for revascularization to improve prognosis and reduce symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: ; John Fani Srour, M.D.; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

==ACC/AHA Guidelines- Revascularization with PTCA (or other catheter-based techniques) and CABG (DO NOT EDIT)  == {{cquote|

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

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: A)

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: A)

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

5. PTCA 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 noninvasive testing. (Level of Evidence: B)

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 PTCA, CABG or PTCA for recurrent stenosis associated with a large area of viable myocardium and/or high-risk criteria on noninvasive testing. (Level of Evidence: C)

8. PTCA or CABG for patients who have not been successfully treated by medical therapy and can undergo revascularization with acceptable risk. (Level of Evidence: B)

Class IIa
1. Repeat CABG for patients with multiple saphenous vein graft stenoses, especially when there is significant stenosis of a graft supplying the left anterior descending coronary artery. PTCA may be appropriate for focal saphenous vein graft lesions or multiple stenoses in poor candidates for reoperative surgery. (Level of Evidence: C)

2. PTCA 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: B)

3. PTCA or CABG for patients with one-vessel disease with significant proximal left anterior descending CAD. (Level of Evidence: B)

Class IIb
1. Compared with CABG, PTCA 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. PTCA for patients with significant left main coronary disease who are not candidates for CABG. (Level of Evidence: C)

3. PTCA 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)

Class III
1. PTCA or CABG for patients with one- or two-vessel CAD without significant left anterior descending CAD who have mild symptoms that are unlikely due to myocardial ischemia or have not received an adequate trial of medical therapy and
 * a. have only a small area of viable myocardium, or
 * b. have no demonstrable ischemia on noninvasive testing. (Level of Evidence: C)

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

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

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

==ESC Guidelines- Revascularization to Improve Prognosis (DO NOT EDIT) == {{cquote|

Class I
1. CABG for signiﬁcant left main CAD or its equivalent (i.e., severe stenosis of ostial/proximal segment of left descending and circumﬂex coronary arteries). (Level of Evidence: A)

2. CABG for signiﬁcant proximal stenosis of three major vessels, particularly in those patients with abnormal LV function or with early or extensive reversible ischemia on functional testing. (Level of Evidence: A)

3. CABG for one- or two-vessel disease with high-grade stenosis of proximal LAD with reversible ischemia on non-invasive testing. (Level of Evidence: A)

4. CABG for signiﬁcant disease with impaired LV function and viability demonstrated by non-invasive testing. (Level of Evidence: B)

Class IIa
1. CABG for one- or two-vessel CAD without signiﬁcant proximal LAD stenosis in patients who have survived sudden cardiac death or sustained ventricular tachycardia. (Level of Evidence: B)

2. CABG for signiﬁcant three-vessel disease in diabetics with reversible ischemia on functional testing. (Level of Evidence: C)

3. PCI or CABG for patients with reversible ischemia on functional testing and evidence of frequent episodes of ischemia during daily activities. (Level of Evidence: C)}}

==ESC Guidelines- Revascularization to Improve Symptoms (DO NOT EDIT) == {{cquote|

Class I
1. CABG for multi-vessel disease technically suitable for surgical revascularization in patients with moderate-to-severe symptoms not controlled by medical therapy, in whom risks of surgery do not outweigh potential beneﬁts. (Level of Evidence: A)

2. PCI for one-vessel disease technically suitable for percutaneous revascularization in patients with moderate-to-severe symptoms not controlled by medical therapy, in whom procedural risks do not outweigh potential beneﬁts. (Level of Evidence: A)

3. PCI for multi-vessel disease without high-risk coronary anatomy, technically suitable for percutaneous revascularization in patients with moderate-to-severe symptoms not controlled by medical therapy, in whom procedural risks do not outweigh potential beneﬁts. (Level of Evidence: A)

Class IIa
1. PCI for one-vessel disease technically suitable for percutaneous revascularization in patients with mild-to-moderate symptoms which are nonetheless unacceptable to the patient, in whom procedural risks do not outweigh potential beneﬁts. (Level of Evidence: A)

2. CABG for one-vessel disease technically suitable for surgical revascularization in patients with moderate-to-severe symptoms not controlled by medical therapy, in whom operative risk does not outweigh potential beneﬁt. (Level of Evidence: A)

3. CABG for multi-vessel disease technically suitable for surgical revascularization in patients with mild-to-moderate symptoms which are nonetheless unacceptable to the patient, in whom operative risk does not outweigh potential beneﬁt. (Level of Evidence: A)

4. PCI for multi-vessel disease technically suitable for percutaneous revascularization in patients with mild-to-moderate symptoms which are nonetheless unacceptable to the patient, in whom procedural risks do not outweigh potential beneﬁts. (Level of Evidence: A)

Class IIb
1. CABG for one-vessel disease technically suitable for surgical revascularization in patients with mild-to-moderate symptoms which are nonetheless unacceptable to the patient, in whom operative risk is not greater than the estimated annual mortality. (Level of Evidence: B)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

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


 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology