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ACC/AHA guidelines for CABG

Asymptomatic

Class I

  • CABG should be performed in patients with asymptomatic ischaemia or mild angina who have significant left main coronary artery stenosis.
  • CABG should be performed in patients with asymptomatic ischaemia or mild angina who have left main equivalent: significant (greater than or equal to 70%) stenosis of the proximal LAD and proximal left circumflex artery.
  • CABG is useful in patients with asymptomatic ischemia or mild angina who have 3-vessel disease. (Survival benefit is greater in patients with abnormal LV function; e.g., ejection fraction [EF] less than 0.50 and/or large areas of demonstrable myocardial ischaemia.)

Class IIa

  • CABG can be beneficial for patients with asymptomatic or mild angina who have proximal LAD stenosis with 1- or 2-vessel disease. (This recommendation becomes Class I if extensive ischaemia is documented by a noninvasive study and/or LVEF is less than 0.50.)

Class IIb

  • CABG may be considered for patients with asymptomatic or mild angina who have 1- or 2-vessel disease not involving the proximal LAD. (If a large area of viable myocardium and high-risk criteria are met on noninvasive testing, this recommendation becomes a Class I.)
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Asymptomatic

Class I

  • CABG should be performed in patients with asymptomatic ischaemia or mild angina who have significant left main coronary artery stenosis.
  • CABG should be performed in patients with asymptomatic ischaemia or mild angina who have left main equivalent: significant (greater than or equal to 70%) stenosis of the proximal LAD and proximal left circumflex artery.
  • CABG is useful in patients with asymptomatic ischemia or mild angina who have 3-vessel disease. (Survival benefit is greater in patients with abnormal LV function; e.g., ejection fraction [EF] less than 0.50 and/or large areas of demonstrable myocardial ischaemia.)

Class IIa

  • CABG can be beneficial for patients with asymptomatic or mild angina who have proximal LAD stenosis with 1- or 2-vessel disease. (This recommendation becomes Class I if extensive ischaemia is documented by a noninvasive study and/or LVEF is less than 0.50.)

Class IIb

  • CABG may be considered for patients with asymptomatic or mild angina who have 1- or 2-vessel disease not involving the proximal LAD. (If a large area of viable myocardium and high-risk criteria are met on noninvasive testing, this recommendation becomes a Class I.)
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