Table 4

Method of Revascularization: Multivessel CAD, CCS Angina Greater Than or Equal to Class III, and/or Evidence of Intermediate- to High-Risk Findings on Noninvasive Testing

IndicationAppropriate Use Score (1–9)
PCICABG
62.•  Two-vessel CAD with proximal LAD stenosisA (7)A (8)
63.•  Three-vessel CAD with low CAD burden (i.e., 3 focal stenoses, low SYNTAX score)A (7)A (9)
64.•  Three-vessel CAD with intermediate to high CAD burden (i.e., multiple diffuse lesions, presence of CTO, or high SYNTAX score)U (4)A (9)
65.•  Isolated left main stenosisU (6)A (9)
66.•  Left main stenosis and additional CAD with low CAD burden (i.e., 1- to 2-vessel additional involvement, low SYNTAX score)U (5)A (9)
67.•  Left main stenosis and additional CAD with intermediate to high CAD burden (i.e., 3-vessel involvement, presence of CTO, or high SYNTAX score)I (3)A (9)
68.
  • Prior bypass surgery with native 3-vessel disease and failure of multiple bypass grafts

  • LIMA remains patent to a native coronary artery

  • Depressed LVEF

U (6)A (7)
69.
  • Prior bypass surgery with native 3-vessel disease and failure of multiple bypass grafts

  • LIMA was used as a graft but is no longer functional

  • Depressed LVEF

A (8)U (6)

New and updated indications are shaded blue.

A = appropriate; CABG = coronary artery bypass graft; CAD = coronary artery disease; CCS = Canadian Cardiovascular Society; CTO = chronic total occlusion; I = inappropriate; LAD = left anterior descending coronary artery; LIMA = left internal mammary artery; LVEF = left ventricular ejection fraction; PCI = percutaneous coronary intervention; SYNTAX = Synergy Between PCI With TAXUS and Cardiac Surgery; U = uncertain.

  • The 2009 appropriate use criteria (1) separated out diabetes and normal or depressed LVEF for the indications in this table, but they were combined for the focused update because these clinical variables did not affect the ratings.