Summary of the AHA / ACC Guidelines 2004
Circulation – 110:1168-76

• CABG should be performed in patients with asymptomatic ischemia or mild angina who have significant left main coronary artery stenosis. (Level of Evidence: A)

• CABG should be performed in patients with asymptomatic ischemia 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. (Level of Evidence: A)

• 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; eg, ejection fraction [EF] less than 0.50 and/or large areas of demonstrable myocardial ischemia.) (Level of Evidence: C)

Class II a

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

Class II b

• CABG may be considered for patients with asymptomatic ischaemia 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 Class I.) (Level of Evidence: B)

• CABG is recommended for patients with stable angina who have significant left main coronary artery stenosis. (Level of Evidence: A)

• CABG is recommended for patients with stable angina who have left main equivalent: significant (greater than or equal to 70%) stenosis of the proximal LAD and proximal left circumflex artery. (Level of Evidence: A)

• CABG is recommended for patients with stable angina who have 3-vessel disease. (Survival benefit is greater when LVEF is less than 0.50.) (Level of Evidence: A)

• CABG is recommended in patients with stable angina who have 2-vessel disease with significant proximal LAD stenosis and either EF less than 0.50 or demonstrable ischemia on noninvasive testing. (Level of Evidence: A)

• CABG is beneficial for patients with stable angina who have 1- or 2-vessel CAD without significant proximal LAD stenosis but with a large area of viable myocardium and high-risk criteria on noninvasive testing. (Level of Evidence: B)

• CABG is beneficial for patients with stable angina who have developed disabling angina despite maximal noninvasive therapy, when surgery can be performed with acceptable risk. If the angina is not typical, objective evidence of ischemia should be obtained. (Level of Evidence: B)

Class II a

• CABG is reasonable in patients with stable angina who have proximal LAD stenosis with 1-vessel disease. (This recommendation becomes Class I if extensive ischemia is documented by noninvasive study and/or LVEF is less than 0.50.) (Level of Evidence: A)

• CABG may be useful for patients with stable angina who have 1- or 2-vessel CAD without significant proximal LAD stenosis but who have a moderate area of viable myocardium and demonstrable ischemia on noninvasive testing. (Level of Evidence: B)

Class III

• CABG is not recommended for patients with stable angina who have 1- or 2-vessel disease not involving significant proximal LAD stenosis, patients who have mild symptoms that are unlikely due to myocardial ischemia, or patients who have not received an adequate trial of medical therapy and the following:
  a. Have only a small area of viable myocardium (Level of Evidence: B) or
  b. Have no demonstrable ischemia on noninvasive testing. (Level of Evidence: B)

• CABG is not recommended for patients with stable angina who have 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: B)

• CABG is not recommended for patients with stable angina who have insignificant coronary stenosis (less than 50% diameter reduction). (Level of Evidence: B)

• CABG should be performed for patients with unstable angina/non–ST-segment elevation MI with significant left main coronary artery stenosis. (Level of Evidence: A)

• CABG should be performed for patients with unstable angina/non–ST-segment elevation MI who have left main equivalent: significant (greater than or equal to 70%) stenosis of the proximal LAD and proximal left circumflex artery. (Level of Evidence: A)

• CABG is recommended for unstable angina/non–ST-segment elevation MI in patients in whom revascularization is not optimal or possible and who have ongoing ischemia not responsive to maximal nonsurgical therapy. (Level of Evidence: B)

Class II a

• CABG is probably indicated in patients with unstable angina/non–ST-segment elevation MI who have proximal LAD stenosis with 1- or 2-vessel disease. (Level of Evidence: A)

Class II b

• CABG may be considered for patients with unstable angina/non–ST-segment elevation MI who have 1- or 2-vessel disease not involving the proximal LAD when percutaneous revascularization is not optimal or possible. (If there is a large area of viable myocardium and high-risk criteria are met on noninvasive testing, this recommendation becomes Class I.) (Level of Evidence: B)

• CABG should be performed in patients with poor LV function who have significant left main coronary artery stenosis. (Level of Evidence: B)

• CABG should be performed in patients with poor LV function who have left main equivalent: significant (greater than or equal to 70%) stenosis of the proximal LAD and proximal left circumflex artery. (Level of Evidence: B)

• CABG should be performed in patients with poor LV function who have proximal LAD stenosis with 2- or 3-vessel disease. (Level of Evidence: B)

Class II a

• CABG may be performed in patients with poor LV function with significant viable non contracting, revascularizable myocardium and without any of the above anatomic patterns. (Level of Evidence: B)

Class III

• CABG should not be performed in patients with poor LV function without evidence of intermittent ischemia and without evidence of significant revascularizable viable myocardium. (Level of Evidence: B)

Go Top