CABG to improve survival is reasonable in patients with significant (>70% diameter) stenoses in 2 major coronary arteries with severe or extensive Table 3. 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 I CABG I PCI 1 significant stenoses and unacceptable angina in whom GDMT cannot be implemented because of medication contraindications, adverse effects, or patient preferences IIa CABG IIa PCI C N/A Previous CABG with 1 significant stenoses associated with ischemia and unacceptable angina despite GDMT IIa PCI C 86,89,92 IIb CABG C 93 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 32,46,56,71,72 Viable ischemic myocardium that is perfused by coronary arteries that are not amenable to grafting IIb TMR as an adjunct to CABG No anatomic or physiologic criteria for revascularization III: Harm CABG 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 applicable; PCI, percutaneous coronary intervention; SYNTAX, Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery; and TMR, transmyocardial laser revascularization. myocardial ischemia (eg, high-risk criteria on stress testing, abnormal intracoronary hemodynamic eval- uation, or >20% perfusion defect by myocardial perfusion stress imaging) or target vessels supplying a large area of viable myocardium.60 63 (Level of Evidence: B) 2. 