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. 2022 Mar 15;2(2):119–138. doi: 10.1016/j.jacasi.2021.12.011

Table 3.

Recent Changes of PCI Recommendation Guidelines for LMCA Disease

Guidelines Class of Recommendation Level of Evidence
Pre-EXCEL and NOBLE
 2014 ESC/EACTS55 I: LMCA disease with a SYNTAX score of ≤22
IIa: LMCA disease with a SYNTAX score of 23–32
III: LMCA disease with a SYNTAX score of ≥33		 B
 2014 ACC/AHA57 IIa: For SIHD patients 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 outcomes (eg, a low SYNTAX score of ≤22, ostial or trunk LMCA stenosis)

  • •

    Clinical characteristics that predict a significantly increased risk of adverse surgical outcomes (eg, STS-predicted risk of operative mortality of >5%)

IIb: For SIHD patients 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, distal bifurcation LMCA stenosis)

  • •

    Clinical characteristics that predict an increased risk of adverse surgical outcomes (eg, moderate-severe chronic obstructive pulmonary disease, disability from previous stroke, or previous cardiac surgery; STS-predicted risk of operative mortality of >2%)

III: For SIHD patients (vs performing CABG) with unfavorable anatomy for PCI and who are good candidates for CABG		 B
B
B
Post-EXCEL and NOBLE
 2018 ESC/EACTS56 I: LMCA disease with a SYNTAX score of ≤22
IIa: LMCA disease with a SYNTAX score of 23–32
III: LMCA disease with a SYNTAX score of ≥33		 A
 2021 ACC/AHA58 IIa: In selected patients with SIHD and significant LMCA disease for whom PCI can provide equivalent revascularization to that possible with CABG, PCI is reasonable to improve survival. B

ACC = American College of Cardiology; AHA = American Heart Association; EACTS = European Association for Cardio-Thoracic Surgery; ESC = European Society of Cardiology; SIHD = stable ischemic heart disease; STS = Society of Thoracic Surgeons; other abbreviations as in Tables 1 and 2.