A Heart Team approach to revascularization is recommended in patients with unprotected left main or complex CAD.950 952 (Level of Evidence: C) Fihn et al Stable Ischemic Heart Disease: Full Text e413 Table 18. Revascularization to Improve Survival Compared With Medical Therapy Anatomic Setting COR LOE References UPLM or complex CAD CABG and PCI I Heart Team approach recommended C (950 952) CABG and PCI IIa Calculation of STS and SYNTAX scores B (949, 950, 953 957) UPLM* PCI IIa For SIHD when both of the following are present: Anatomic conditions associated with a low risk of PCI procedural complications and a high likelihood of good long-term outcome (eg, a low SYNTAX score of #22, ostial or trunk left main CAD) Clinical characteristics that predict a significantly increased risk of adverse surgical outcomes (eg, STS-predicted risk of operative IIa For UA/NSTEMI if not a CABG candidate B (949, 968 971, 976 979, 981) IIa For STEMI when distal coronary flow is TIMI flow grade ,3 and PCI can be performed more rapidly and safely than CABG IIb For SIHD when both of the following are present: Anatomic conditions associated with a low to intermediate risk of PCI procedural complications and an intermediate to high likelihood of good long-term outcome (eg, low-intermediate SYNTAX score of ,33, bifurcation left main CAD) Clinical characteristics that predict an increased risk of adverse surgical outcomes (eg, moderate severe COPD, disability from prior stroke, or prior cardiac surgery; STS-predicted operative mortality III: Harm For SIHD in patients (versus performing CABG) with unfavorable anatomy for PCI and who are good candidates for CABG 3-vessel disease with or without proximal LAD artery disease* IIa It is reasonable to choose CABG over PCI in patients with complex 3-vessel CAD (eg, SYNTAX score .22) who are good candidates for CABG 2-vessel disease with proximal LAD artery disease* 2-vessel disease without proximal LAD artery disease* CABG IIa With extensive ischemia B (327, 990 992) IIb Of uncertain benefit without extensive ischemia C (987) 1-vessel proximal LAD artery disease CABG IIa With LIMA for long-term benefit B (412, 987, 993, 994) 1-vessel disease without proximal LAD artery involvement LV dysfunction PCI Insufficient data N/A (Continued) Class IIa 1. 