Sandbox: CR
Template:ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/ STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]
Revascularization to Improve Survival Compared With Medical Therapy (DO NOT EDIT)
| Anatomic Setting | COR | LOE |
|---|---|---|
| UPLM or complex CAD | ||
| CABG and PCI | I—Heart Team approach recommended | C |
| CABG and PCI | IIa—Calculation of STS and SYNTAX scores | B |
| UPLM | ||
| CABG | I | B |
| PCI | IIa - For SIHD when both of the following are present: 1) Anatomic conditions associated with a low risk of PCI procedural complications and a high likelihood of good long-term outcome (e.g., a low SYNTAX score of ≤ 22, ostial or trunk left main CAD) 2) Clinical characteristics that predict a significantly increased risk of adverse surgical outcomes (e.g., STS-predicted risk of operative mortality ≥ 5%) | B |
| PCI | IIa—For UA/NSTEMI if not a CABG candidate | B |
| PCI | IIa—For STEMI when distal coronary flow is TIMI flow grade <3 and PCI can be performed more rapidly and safely than CABG | C |
| PCI | IIb—For SIHD when both of the following are present:1) Anatomic conditions associated with a low to intermediate risk of PCI procedural complications and an intermediate to high likelihood of good long-term outcome (e.g., low-intermediate SYNTAX score of <33, bifurcation left main CAD) 2) Clinical characteristics that predict an increased risk of adverse surgical outcomes (e.g., moderate—severe COPD, disability from prior stroke, or prior cardiac surgery; STS-predicted operative mortality >2%) | B |
| PCI | III: Harm—For SIHD in patients (versus performing CABG) with unfavorable anatomy for PCI and who are good candidates for CABG | B |
| 3-vessel disease with or without proximal LAD artery disease | ||
| CABG | I | B |
| IIa—It is reasonable to choose CABG over PCI in patients with complex 3-vessel CAD (e.g., SYNTAX score >22) who are good candidates for CABG. | B | |
| PCI | IIb—Of uncertain benefit | B |
| 2-vessel disease with proximal LAD artery disease | ||
| CABG | I | B |
| PCI | IIb—Of uncertain benefit | B |
| 2-vessel disease without proximal LAD artery disease | ||
| CABG | IIa—With extensive ischemia | B |
| CABG | IIb—Of uncertain benefit without extensive ischemia | C |
| CABG | IIb—Of uncertain benefit | B |
| 1-vessel proximal LAD artery disease | ||
| CABG | IIa—With LIMA for long-term benefit | B |
| PCI | IIb—With LIMA for long-term benefit | B |
| 1-vessel proximal LAD artery disease | ||
| CABG | III: Harm | B |
| PCI | III: Harm | B |
| LV dysfunction | ||
| CABG | IIa—EF 35% to 50% | B |
| CABG | IIb—EF <35% without significant left main CAD | B |
| PCI | Insufficient data | |
| Survivors of sudden cardiac death with presumed ischemia-mediated VT | ||
| CABG | I | B |
| PCI | I | C |
| No anatomic or physiological criteria for revascularization | ||
| CABG | III: Harm | B |
| PCI | III: Harm | B |