Indications for Myocardial Revascularization Surgery

Indications for Prognostic Improvement (Class I)

• The European Society of Cardiology recommends CABG to improve prognosis in patients with left main coronary artery disease >50%, multivessel disease with left ventricular dysfunction (LVEF ≤35%), and proximal left anterior descending artery disease, as well as to alleviate symptoms refractory to optimal medical treatment 1, 2
• The European Society of Cardiology indicates that CABG is the preferred strategy over percutaneous coronary intervention (PCI) in patients with acceptable surgical risk 2

Indications for Symptomatic Improvement (Class I)

• The European Society of Cardiology recommends revascularization for patients with limiting or equivalent angina and insufficient response to optimal medical treatment 1, 3
• The American College of Cardiology recommends CABG as the first-line strategy in patients with multivessel disease and acceptable surgical risk 2, 5

Considerations for Choosing between CABG and PCI

• The European Society of Cardiology recommends calculating the SYNTAX score to evaluate the complexity of coronary anatomy and long-term risk in patients with left main or multivessel disease 1
• The American College of Cardiology recommends calculating the STS score to evaluate 30-day mortality and hospital morbidity after CABG 1

Important Warnings

• The American College of Cardiology warns that PCI with stent placement should not be performed if the patient cannot tolerate or comply with dual antiplatelet therapy (DAPT) for the appropriate duration 6, 7
• The European Society of Cardiology emphasizes that the prognostic and symptomatic benefit of myocardial revascularization depends critically on the completeness of revascularization 1