Because the STS score and the SYNTAX score have been shown to predict adverse outcomes in patients undergoing CABG and PCI, respectively, calculation of these scores is often useful in making revascularization decisions.13,14,17 22 Table 2. 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 14 16 CABG and PCI IIa Calculation of STS and SYNTAX scores B 13,14,17 22 UPLM* CABG I B 24 30 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 mortality 5%) IIa For UA/NSTEMI if not a CABG candidate B 13,36 39,44,45,47 49 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 risk of operative mortality 2%) 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* CABG I B 26,30,53 56 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 PCI IIb Of uncertain benefit B 26,46,53,56,82 2-vessel disease with proximal LAD artery disease* CABG I B 26,30,53 56 PCI IIb Of uncertain benefit B 26,53,56,82 2-vessel disease without proximal LAD artery disease* CABG IIa With extensive ischemia B 60 63 IIb Of uncertain benefit without extensive ischemia C 56 PCI IIb Of uncertain benefit B 26,53,56,82 1-vessel proximal LAD artery disease CABG IIa With LIMA for long-term benefit B 30,56,69,70 PCI IIb Of uncertain benefit B 26,53,56,82 1-vessel disease without proximal LAD artery involvement CABG III: Harm B 30,53,60,61,94 98 PCI III: Harm B 30,53,60,61,94 98 LV dysfunction CABG IIb EF 35% without significant left main CAD B 30,64 68,83,84 PCI Insufficient data N/A Survivors of sudden cardiac death with presumed ischemia-mediated VT CABG I B 57 59 PCI I C 57 No anatomic or physiologic criteria for revascularization CABG III: Harm B 30,53,60,61,94 98 PCI III: Harm B 30,53,60,61,94 98 *In patients with multivessel disease who also have diabetes, it is reasonable to choose CABG (with LIMA) over PCI62,74 81 (Class IIa; LOE: B). 