Coronary Bypass Surgery Indications

Question 0

Class I indications for stable Angina

Answer 0

Left main stenosis
Left main equivalent
Three vessel disease
Two vessel disease with proximal LAD stenosis and EF < 50% or demonstrable ischemia
One or two vessel disease without proximal LAD stenosis but with large territory at risk and high risk-criteria on noninvasive testing
Disabling angina refractory medical therapy

Question 1

What are Class I indications for CABG in pt who is Aymptomatic or only mild Angina

Answer 1

Left main stenosis
Left main equivalent (proximal LAD and proximal circumflex)
Three-vessel disease

Question 2

What is indication in Unstable Angina/NSTEMI

Answer 2

Left main
Left main equivalent
On going ischemia not responsive to maximal nonsurgical

Question 3

What is indication for ST elevation MI

Answer 3

Failed PCI with persistent pain or shock or anatomically feasible
persistent or recurrent ischmia refractory to medical treatment with acceptable anatomy who have a signficant territory at risk and not a candidate for PCI
requires surgical repair for post-infarct VSD or MR
cardiogenic shock in pts< 75 years of age who have ST elevatio, LBB< or a posterior MI wihtin 18 hours of onset
life threatening ventricular arrhythmia in the presence of > 50% left main stenosis or 3VD

Question 4

What is class I indication for Poor LV function

Answer 4

Left main stenosis
Left main equivalent
proximal LAD and two to 3 vessel disease

Question 5

What is class I in previous CABG

Answer 5

Disabling angina refractory to medical therapy 
Non patient previous bypass grafts but with class I indications for native CAD