Cabg indications

Indications of CABG

1. Indications for CABG

2. CABG is performed for both symptomatic and prognostic reasons Indications for CABG have been classified by the ACC& AHA according to the level of evidence supporting the usefulness and efficacy of the procedure Class I - Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective Class II - Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness or efficacy of a procedure or treatment Class IIa - Weight of evidence or opinion is in favor of usefulness or efficacy Class IIb - Usefulness or efficacy is less well established by evidence or opinion Class III - Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful or effective, and in some cases it may be harmful

3. Indication Asymptomatic or Mild Angina Stable Angina Unstable Angina/ NSTEMI Poor LV Function Left main stenosis >50% Class I Class I Class I Class I Stenosis of proximal LAD and proximal circumflex >70% Class I Class I Class I Class I 3-vessel disease Class I Class I   Class I, with proximal LAD stenosis 2-vessel disease   Class I if there is large area of viable myocardium in high-risk area Class IIa if there is moderate viable area and ischemia Class IIb  

4. Indication Asymptomatic or Mild Angina Stable Angina Unstable Angina/ NSTEMI Poor LV Function With >70% proximal LAD stenosis Class IIa Class I with either ejection fraction < 50% or demonstrable ischemia on noninvasive testing Class IIa Class I Involving proximal LAD Class IIb       1-vessel disease   Class I if there is large area of viable myocardium in high-risk area Class IIa , if there is viable moderate area and ischemia Class IIb  

5. Indication Asymptomatic or Mild Angina Stable Angina Unstable Angina/ NSTEMI Poor LV Function With >70% proximal LAD stenosis Class IIa Class IIa Class IIa   Involving proximal LAD Class IIb    

6. Other indications for CABG Disabling angina (Class I) Ongoing ischemia in the setting of a non-ST segment elevation myocardial infarction that is unresponsive to medical therapy (Class I) Poor left ventricular function but with viable, nonfunctioning myocardium above the anatomical defect that can be revascularized

7. CABG may be performed as an emergency procedure in the context of a STEMI in cases where it has not been possible to perform PCI or where this procedure has failed and there is persistent pain and ischemia threatening a significant area of myocardium despite medical therapy CABG in STEMI

8. Other indications for CABG in the setting of STEMI are: ventricular septal defect related to myocardial infarction papillary muscle rupture free wall rupture ventricular pseudoaneurysm life-threatening ventricular arrhythmias, and cardiogenic shock

9. References [Guideline] Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.  Circulation . 2011 Nov 7. [Medline ] Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery).  Circulation . 2004 Aug 31. 110(9):1168-76.  [Medline ] http://emedicine.medscape.com/article/1893992-overview#a3