In patients with a patent LIMA to the LAD artery and ischemia in the distribution of the right or left circumflex coronary arteries, it is reasonable to recommend reoperative CABG to treat angina if GDMT has failed and the coronary stenoses are not amenable to PCI.380,1227 (Level of Evidence: B) 6.8.1. Indications for Repeat CABG RCTs comparing medical therapy to CABG in subjects with SIHD demonstrated that those with specific angiographic findings, such as left main disease, 3-vessel disease, and 2-vessel disease that includes the proximal LAD artery, derive a survival benefit from CABG.318 At the same time, it is unknown if CABG provides a survival benefit compared with medical therapy in patients with these anatomic findings who have had previous CABG. It is logical to assume that subjects with previous CABG and these anatomic findings would, in fact, derive a survival benefit from repeat CABG provided that CABG could be performed with an acceptable risk. The importance of recurrent MI in the distribution of the Hillis et al 2011 ACCF/AHA CABG Guideline e697 LAD artery has been shown to be associated with a poor prognosis in patients with previous CABG. The long-term outcomes of 723 patients with diseased SVGs who did not undergo reoperation or PCI within 1 year of angiography were reviewed.1228 A stenosis of a graft to the LAD artery was associated with decreased rates of survival, reoperation- free survival, and event-free survival. On the basis of these data, these authors suggest that a 50% stenosis in a graft to the LAD artery is an indication for reoperation. In contrast, patients without ischemia in the LAD artery distribution do not derive a survival benefit from repeat CABG. 