Unstable angina non ST elevation myocardial infarction recommendations for CABG
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Overview of Recommendations for CABG in UA / NSTEMI
ACC / AHA Guidelines (DO NOT EDIT) [1]
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Class I1. Coronary artery bypass graft surgery is recommended for UA / NSTEMI patients with significant left main CAD (>50% stenosis). (Level of Evidence: A) 2. Coronary artery bypass graft surgery is recommended for UA / NSTEMI patients with 3-vessel disease; the survival benefit is greater in patients with abnormal LV function (LVEF<50%). (Level of Evidence: A) 3. Coronary artery bypass graft surgery is recommended for UA / NSTEMI patients with 2 vessel disease with significant proximal LAD disease and either abnormal LV function (LVEF <50%) or ischemia on non invasive testing. (Level of Evidence: A) 4. Coronary artery bypass graft surgery is recommended for UA / NSTEMI patients in whom percutaneous coronary revascularization is not optimal or possible and who have ongoing ischemia not responsive to maximal nonsurgical therapy. (Level of Evidence: B) 5. Coronary artery bypass graft surgery (or PCI) is recommended for UA / NSTEMI patients with 1 or 2 vessel CAD with or 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. Coronary artery bypass graft surgery (or PCI) is recommended for UA / NSTEMI patients with multivessel coronary disease with suitable coronary anatomy, with normal LV function, and without diabetes mellitus. (Level of Evidence: A) Class IIa1. For patients with UA / NSTEMI and multi vessel disease, CABG with use of the internal mammary arteries can be beneficial over PCI in patients being treated for diabetes. (Level of Evidence: B) 2. It is reasonable to perform CABG with the internal mammary artery for UA / NSTEMI patients with multi vessel disease and treated diabetes mellitus. (Level of Evidence: B) 3. Repeat CABG is reasonable for UA / NSTEMI patients with multiple SVG stenoses, especially when there is significant stenosis of a graft that supplies the LAD. (Level of Evidence: C) 4. Coronary artery bypass graft surgery (or PCI) is reasonable for UA / NSTEMI patients with 1 or 2 vessel CAD with or without significant proximal left anterior descending CAD but with a moderate area of viable myocardium and ischemia on non invasive testing. (Level of Evidence: B) 5. Coronary artery bypass graft surgery (or PCI) can be beneficial compared with medical therapy for UA / NSTEMI patients with 1 vessel disease with significant proximal left anterior descending CAD. (Level of Evidence: B) 6. Coronary artery bypass surgery (or PCI with stenting) is reasonable for patients with multi vessel disease and symptomatic myocardial ischemia. (Level of Evidence: B) Class IIb1. Coronary artery bypass graft surgery may be considered in patients with UA / NSTEMI who have 1 or 2 vessel disease not involving the proximal LAD with a modest area of ischemic myocardium when percutaneous revascularization is not optimal or possible. (If there is a large area of viable myocardium and high-risk criteria on non invasive testing, this recommendation becomes a Class I recommendation.) (Level of Evidence: B) Class III1. Coronary artery bypass graft surgery (or PCI) is not recommended for patients with 1- or 2-vessel CAD without significant proximal left anterior descending CAD without current symptoms or symptoms that are unlikely to be due to myocardial ischemia and who have no ischemia on non invasive testing. (Level of Evidence: C) |
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See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
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