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Ghiduri ale Societatii Europene de Cardiologie
Table 8 Summary of recommendations for revascularization in stable angina
Indication For prognosis a For symptoms b Studies
PCI (assuming suitable anatomy for PCI, appropriate r
Class of Level of Class of Level of
recommendation evidence recommendation evidence
isk stratification, and discussion with the patient)
Angina CCS classes 1 IV despite medical therapy I A ACME and MASS
with one-vessel disease
Angina CCS classes 1 IV despite medical therapy I A RITA 2 and VA-ACME
with multi-vessel disease (non-diabetic)
Stable angina with minimal (CCS class I) symptoms IIb С ACIP
on medication and one-, two-, or three-vessel
disease but objective evidence of large ischaemia
CABG (assuming suitable anatomy for surgery, appropriate risk stratification, and discussion with the patient)
Angina and LM stem disease i A i A CASS, European
Coronary Surgery
study, VA Study,
and Yusef
meta-analysis
Angina and three-vessel disease with objective I A I A
large ischaemia
Angina and three-vessel disease with poor I A I A
ventricular function
Angina with two- or three-vessel disease including I A I A
severe disease of the proximal LAD
Angina CCS classes 1 IV with multi-vessel IIa В I В BARI, GABI, ERACI-I,
disease (diabetic)
SoS, ARTs,
Yusef et al.,
Hoffman et al.
Angina CCS classes 1 IV with multi-vessel 1 A
disease (non-diabetic)
Angina CCS classes 1 IV despite medical therapy I В MASS
and one-vessel disease including severe
disease of the proximal LAD
Angina CCS classes 1 IV despite medical therapy IbB В
and one-vessel disease not including severe
disease of the proximal LAD
Angina with minimal (CCS class I) symptoms on IIb С ACIP
medication and one-, two-, or three-vessel
disease but objective evidence of large ischaemia
Recommendations for revascularization on symptomatic grounds take into account the range of
grades for which evidence is available and
should be construed in this fashion rather than as a directive to perform revascularization across the entire range of symtomatology.
CCS, Canadian Cardiovascular Society.
a Relates to effects on mortality, cardiac or cardiovascular mortality, or mortality combined with MI.
b Relates to changes in angina class, exercise duration, time to angina on treadmill testing,repeat hospitalization forang , repeat hospitalization for i for or other parameters of
functional capacity or quality of life.
Recomandările revascularizării pentru îmbunătăţirea
prognosticului pacienţilor cu angina stabilă
Clasa I
1. CABG pentru left main sau echivalenţe (de ex. stenoza
severă proximală/ostială a descendentei stângi
sau a circumflexei) (nivel de evidenţă A)
2. CABG pentru stenoza proximală semnificativă trivasculară,
în mod particular la acei pacienţi care au
funcţie VS anormală sau cu ischemie întinsă reversibilă
la teste de efort (nivel de evidenţă A)
3. CABG pentru boala coronariană uni sau bivasculară
cu grad crescut de stenoză al LAD proximale cu
ischemie reversibilă la testele non-invazive (nivel
de evidenţă B)
4. CABG pentru boala semnificativă cu funcţie ventriculară
stângă diminuată şi viabilitate demonstrată la
testele neinvazive ( nivel de evidenţă B)
Clasa IIa
1. CABG pentru boala coronariană uni sau bivasculară
fără stenoză semnificativă de LAD proximală la
pacienţi care au supravieţuit morţii cardiace subite
sau TV sustinute (nivel de evidenţă B)
2. CABG pentru boală trivasculară semnificativă la
diabetici cu ischemie reversibilă la teste funcţionale
(nivel de evidenţă C)
3. PCI sau CABG la pacienţii cu ischemie reversibilă
la teste funcţionale şi dovada unor episoade frecvente
ischemice în timpul activităţii zilnice (nivel de
evidenţă C)
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