Percutaneous coronary intervention prior coronary bypass surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2005 ACC/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)^[1]

Class I
“1. When technically feasible, PCI should be performed in patients with early ischemia (usually within 30 days) after CABG. (Level of Evidence: B)”
“2. It is recommended that distal embolic protection devices be used when technically feasible in patients undergoing PCI to saphenous vein grafts. (Level of Evidence: B)”

Class III
“1. PCI is not recommended in patients with prior CABG for chronic total vein graft occlusions.(Level of Evidence: B)”
“2. PCI is not recommended in patients who have multiple target lesions with prior CABG and who have multi-vessel disease failure of multiple SVGs, and impaired LV function unless repeat CABG poses excessive risk due to severe comorbid conditions. (Level of Evidence: B)”

Class IIa
“1. PCI is reasonable in patients with ischemia that occurs 1 to 3 years after CABG and who have preserved LV function with discrete lesions in graft conduits. (Level of Evidence: B)”
“2. PCI is reasonable in patients with disabling angina secondary to new disease in a native coronary circulation after CABG. (If angina is not typical, objective evidence of ischemia should be obtained.) (Level of Evidence: B)”
“3. PCI is reasonable in patients with diseased vein grafts more than 3 years after CABG. (Level of Evidence: B)”
“4. PCI is reasonable when technically feasible in patients with a patent left internal mammary artery graft who have clinically significant obstructions in other vessels. (Level of Evidence: C)”