What are 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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Other indications for CABG include the following:

  • Disabling angina (Class I)

  • Ongoing ischemia in the setting of a non-ST segment elevation myocardial infarction (NSTEMI) that is unresponsive to medical therapy (Class I)

  • Poor left ventricular function but with viable, nonfunctioning myocardium above the anatomic defect that can be revascularized

  • Clinically significant CAD of 70% stenosis or greater, in 1 or more vessel(s), and refractory angina despite medical therapy and PCI [23]

  • Clinically significant CAD of 70% stenosis or greater, in 1 or more vessel(s), in survivors of sudden cardiac arrest presumed to be related to ischemic ventricular arrhythmia [23]

  • Clinically significant CAD of 50% stenosis or greater, in 1 or more vessel(s), in patients undergoing cardiac surgery for other indications (eg, valve replacement or aortic surgery) [23]

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 the myocardium despite medical therapy.

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

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