2021 American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions recommendations for CABG vs PCI
| Indication | Criteria and recommendation | Class strength and level of evidence |
|---|---|---|
| Complex disease | Significant left main coronary artery disease with high complexity CABG is recommended over PCI to improve survival | Class 1, level B-R |
| Multivessel disease with complex or diffuse coronary artery disease (SYNTAX score ≥ 33) It is reasonable to choose CABG over PCI to confer survival advantage | Class 2a, level B-R | |
| Diabetes | Multivessel disease with LAD involvement CABG with left IMA to LAD is preferred to PCI to reduce mortality and repeat revascularizations | Class 1, level A |
| Multivessel disease amenable to PCI, indication for revascularization, and poor candidate for surgery PCI can be useful to reduce long-term ischemic outcomes | Class 2a, level B-NR | |
| Left main coronary artery stenosis and low- or intermediate-complexity coronary artery disease in the rest of coronary anatomy Consider PCI as alternative to CABG to reduce major adverse cardiovascular outcomes | Class 2b, level B-R | |
| Previous CABG | Refractory angina on guideline-directed medical therapy attributable to LAD disease CABG over PCI when IMA can be used as conduit to the LAD | Class 2a, level C-LD |
| Complex coronary artery disease CABG over PCI when IMA can be used as a conduit to the LAD | Class 2b, level B-NR | |
| Nonadherence to dual antiplatelet therapy | Multivessel disease amenable to treatment with either PCI or CABG CABG is preferred to PCI | Class 2a, level B-NR |
CABG = coronary artery bypass grafting; IMA = internal mammary (thoracic) artery; LAD = left anterior descending coronary artery; LD = limited data; NR = nonrandomized; PCI = percutaneous coronary intervention; R = randomized; SYNTAX = Synergy Between PCI With Taxus Stents and Cardiac Surgery
Data from reference 8.