What are the American College of Cardiology (ACC) and the American Heart Association (AHA) indications for coronary artery bypass grafting (CABG)?

Updated: Dec 04, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Coronary artery bypass grafting (CABG) is performed for both symptomatic and prognostic reasons. Indications for CABG have been classified by the American College of Cardiology (ACC) and the American Heart Association (AHA) according to the level of evidence supporting the usefulness and efficacy of the procedure [1, 2] :

  • 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

Indications for CABG as detailed by the ACC and the AHA are listed in Table 1 below.

Table 1. ACC/AHA Indications for Coronary Artery Bypass Grafting [1, 2] (Open Table in a new window)

Indication

Asymptomatic or Mild Angina

Stable Angina

Unstable Angina/ NSTEMI

Poor Left Ventricular Function

Left main stenosis >50%

Class I

Class I

Class I

Class I

Stenosis of proximal LAD and proximal circumflex artery >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 a large area of viable myocardium in a high-risk area;

Class IIa if there is a moderate viable area and ischemia

Class IIb

 

With >70% proximal LAD stenosis

Class IIa

Class I with either an 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 a large area of viable myocardium in a high-risk area;

Class IIa, if there is a viable moderate area and ischemia

Class IIb

 

With >70% proximal LAD stenosis

Class IIa

Class IIa

Class IIa

 

Involving proximal LAD

Class IIb

 

 

 

ACC = American College of Cardiology; AHA = American Heart Association; LAD = left anterior descending (artery); NSTEMI = non–ST-segment elevation myocardial infarction.


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