Revascularization to Improve Symptoms With Significant Anatomic (>50% Left Main or >70% Non Left Main CAD) or Physiological (FFR <0.80) Coronary Artery Stenoses Clinical Setting COR LOE References $1 significant stenoses amenable to revascularization and unacceptable angina despite GDMT $1 significant stenoses and unacceptable angina in whom GDMT cannot be implemented because of medication contraindications, adverse effects, or patient preferences IIa CABG C N/A IIa PCI C N/A Previous CABG with $1 significant stenoses associated with ischemia and unacceptable angina despite GDMT IIa PCI C (1021 1024) IIb CABG C (1025) Complex 3-vessel CAD (eg, SYNTAX score .22) with or without involvement of the proximal LAD artery and a good candidate for CABG IIa CABG preferred over PCI B (980, 987 989) Viable ischemic myocardium that is perfused by coronary arteries that are not amenable to grafting IIb TMR as an adjunct to CABG B (923, 927, 929, 1026, No anatomic or physiological criteria for revascularization III: Harm CABG C N/A III: Harm PCI C N/A CABG indicates coronary artery bypass graft; CAD, coronary artery disease; COR, class of recommendation; FFR, fractional flow reserve; GDMT, guideline-directed medical therapy; LOE, level of evidence; N/A, not available; PCI, percutaneous coronary intervention; SYNTAX, Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery; and TMR, transmyocardial revascularization. Fihn et al Stable Ischemic Heart Disease: Full Text e415 have been shown to predict adverse outcomes in patients undergoing CABG and PCI, respectively, calculation of these scores is often useful in making revascularization 5.2. Revascularization to Improve Survival: Recommendations Left Main CAD Revascularization Class I 1. CABG to improve survival is recommended for patients with significant (>50% diameter stenosis) left main coronary artery stenosis.73,381,412,959 962 (Level of Evidence: B) Class IIa 1. 