Chest Pain / Angina Pectoris: Difference between revisions

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===Coronary Artery Bypass Graft===
===Coronary Artery Bypass Graft===
There are circumstances in which CABG should be performed.  
There are circumstances in which CABG should be performed.  
{| class="wikitable" border="1" style="width: 700px"
|-
! style="background: #34abff; color: white; " | Class of recommendations
! style="background: #34abff; color: white" | ACC / AHA 2004 Guideline on CABG <cite>AHACABG</cite>
|-
| style="background: #74fb3f; vertical-align:top;" | '''Class I'''
| style="background: white" | There is evidence and/or general agreement that CABG should be performed in patients with STEMI in the following settings:
#Failed percutaneous coronary intervention (PCI) with persistent pain or hemodynamic instability if coronary anatomy is suitable for surgery.
#Persistent or recurrent ischemia refractory to medical therapy if coronary anatomy is suitable for surgery, a significant area of myocardium is at risk, and the patient is not a candidate for PCI.
#At the time of surgical repair of postinfarction ventricular septal rupture or mitral regurgitation.
#Cardiogenic shock in patients less than 75 years of age who develop shock within 36 hours of MI and are suitable and appropriate candidates for revascularization that can be performed within 18 hours of shock.
#Life-threatening ventricular arrhythmias in the presence of at least 50 percent left main stenosis and/or triple-vessel disease.
If possible, an internal mammary artery graft should be used to bypass a significantly stenosed left anterior descending artery.
|-
| style="background: #fdaa02; vertical-align:top;" | '''Class IIa'''
| style="background: white" | The weight of evidence or opinion is in favor of benefit from CABG in patients with STEMI in the following settings:
#For primary reperfusion in patients who have suitable anatomy, are not candidates for or have failed fibrinolysis/PCI, and are in the first 6 to 12 hours of an evolving STEMI.
#Since CABG mortality is elevated for the first 3 to 7 days after infarction, the benefit of revascularization must be balanced against this risk. Patients who are stable (no ongoing ischemia, hemodynamic compromise, or life-threatening arrhythmia) and who have incurred a significant fall in left ventricular function should have their surgery delayed to allow myocardial recovery to occur. If critical anatomy exists, revascularization should be performed during the index hospitalization.
|-
| style="background: #fdaa02; vertical-align:top;" | '''Class IIb'''
| style="background: white" |
|-
| style="background: #fd3535; vertical-align:top;" | '''Class III'''
| style="background: white" |
There is evidence and/or general agreement that emergency CABG should not be performed in patients with STEMI in the following settings:
#Persistent angina and a small area of myocardium at risk in hemodynamically stable patients.
#Successful epicardial reperfusion in the absence of successful microvascular reperfusion.
|-
| colspan="2" |
<small>''Class I:'' Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective. ''Class II:''
Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure. ''IIa:'' Weight of evidence/opinion is in favour of usefulness/efficacy. ''IIb:'' Usefulness/efficacy is less well established by evidence/opinion. ''Class III'': Evidence or general agreement that the given treatment or procedure is not usefull effective, and in some cases may be harmful.</small>
|}
CABG does not eliminate the stenosis like PCI does. Using the internal thoracic arteries or the saphenous veins from the legs a bypass is made around the stenosis. The bypass originates from the aorta and terminates directly after the stenosis. Thereby restoring the blood supply to the ramifications.
CABG does not eliminate the stenosis like PCI does. Using the internal thoracic arteries or the saphenous veins from the legs a bypass is made around the stenosis. The bypass originates from the aorta and terminates directly after the stenosis. Thereby restoring the blood supply to the ramifications.


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