The AHA Guidelines and Scientifi c Statements Handbook
Class IIb
1 Compared with CABG, PCI may be considered
for patients with two- or three-vessel disease with
signifi cant proximal LAD CAD, who have anatomy
suitable for catheter-based therapy, and who have
treated diabetes or abnormal LV function. (Level of
Evidence: B)
2 Use of PCI may be considered for patients with
signifi cant left main coronary disease who are not
candidates for CABG. (Level of Evidence: C)
3 PCI may be considered for patients with one- or
two-vessel CAD without signifi cant proximal LAD
CAD who have survived sudden cardiac death or
sustained ventricular tachycardia. (Level of Evidence:
C)
Class III
1 Use of PCI or CABG is not recommended for
patients with one- or two vessel CAD without sig-
nifi cant proximal LAD CAD, who have mild symp-
toms that are unlikely due to myocardial ischemia,
or who have not received an adequate trial of medical
therapy and
a. have only a small area of viable myocardium
or
b. have no demonstrable ischemia on noninva-
sive testing. (Level of Evidence: C)
2 Use of PCI or CABG is not recommended for
patients with 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: C)
3 Use of PCI or CABG is not recommended for
patients with insignifi cant coronary stenosis (less
than 50% diameter). (Level of Evidence: C)
4 Use of PCI is not recommended in patients
with signifi cant left main coronary artery disease
who are candidates for CABG. (Level of Evidence:
B)
Recommendations for revascularization to improve
symptoms in patients with stable angina
Class I
1 CABG for multi-vessel disease (MVD) technically
suitable for surgical revascularization is recom-
mended in patients with moderate to severe symp-
toms not controlled by medical therapy, in whom
risks of surgery do not outweigh potential benefi ts.
(Level of Evidence: A)
2 PCI for single vessel disease technically suitable
for percutaneous revascularization is recommended
in patients with moderate to severe symptoms not
controlled by medical therapy, in whom procedural
risks do not outweigh potential benefi ts. (Level of
Evidence: A)
3 PCI for MVD without high risk coronary anatomy,
technically suitable for percutaneous revasculariza-
tion is recommended in patients with moderate to
severe symptoms not controlled by medical therapy
and in whom procedural risks do not outweigh
potential benefi ts. (Level of Evidence: A)Class IIa
1 PCI for single vessel disease technically suit-
able for percutaneous revascularization is reason-
able in patients with mild to moderate symptoms
which are nonetheless unacceptable to the patient,
in whom procedural risks do not outweigh potential
benefi ts. (Level of Evidence: A)
2 CABG for single vessel disease technically suit-
able for surgical revascularization is reasonable
in patients with moderate to severe symptoms not
controlled by medical therapy, in whom operative
risk does not outweigh potential benefi t. (Level of
Evidence: A)
3 CABG in MVD technically suitable for surgical
revascularization is reasonable in patients with mild
to moderate symptoms, which are nonetheless unac-
ceptable to the patient, in whom operative risk does
not outweigh potential benefi t. (Level of Evidence:
A)
4 PCI for MVD technically suitable for percutane-
ous revascularization is reasonable in patients with
mild to moderate symptoms, which are nonetheless
unacceptable to the patient, in whom procedural
risks do not outweigh potential benefi ts. (Level of
Evidence: A)Class IIb
CABG in single vessel disease technically suitable for
surgical revascularization may be considered in
patients with mild-to-moderate symptoms, which
are nonetheless unacceptable to the patient, in
whom operative risk is not greater than estimated
annual mortality. (Level of Evidence: B)