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490 Cardio Diabetes Medicine 2017

intervening MI. The guidelines urge restraint in the computed tomography. Circulation. 2003 Jun 17;107(23):2900-7. Epub
use of routine testing in the follow-up of patients with 2003 May 27.
SIHD if they have not had a change in clinical status . 8. Kevin C Allman, Leslee J Shaw, Rory Hachamovitch, James E Udelson.
Myocardial viability testing and impact of revascularization on prognosis
Summary in patients with coronary artery disease and left ventricular dysfunction:
a meta-analysis. J Am Coll Cardiol. 2002;39(7):1151-1158.
The decision for revascularization should fo-
cus on improvement of survival in patients with SIHD 9. Pim AL. Tonino, Bernard De Bruyne, Nico H.J. Pijls, Uwe Siebert, Fumiaki
Ikeno, Marcel van `t Veer, et al. Fractional Flow Reserve versus Angi-
and high clinical risk for mortality with GDMT and ography for Guiding Percutaneous Coronary Intervention. N Engl J Med
in those who have inadequate control of symptoms 2009; 360:213-224
and quality of life despite GDMT. Recommendations 10. Nico HJ Pijls, Pepijn van Schaardenburgh, Ganesh Manoharan, Eric Boers-
include CABG for patients with significant left main ma, Jan-Willem Bech, Marcel van’t Veer, et al. Percutaneous Coronary
CAD, triple-vessel CAD, or proximal left anterior de- Intervention of Functionally Nonsignificant Stenosis 5-Year Follow-Up of
scending (LAD) disease plus one other major cor- the DEFER Study. J Am Coll Cardiol. 2007;49(21):2105-21
onary artery. CABG is reasonable for patients with
double-vessel CAD who have evidence of severe or
extensive myocardial ischemia or mild to moderate
LV systolic dysfunction with viable myocardium in
the region of intended revascularization. CABG is
given preference over PCI in patients with complex
three-vessel disease and those with diabetes melli-
tus. It is discouraged to use PCI or CABG for single- or
double-vessel CAD without significant involvement
of the proximal LAD artery in the absence of unac-
ceptable angina after an adequate trial of GDMT, par-
ticularly if noninvasive testing data indicate that they
have only a small area of viable myocardium or do
not have extensive ischemia or reduced LV ejection
fraction.
References:
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sclerosis and ischemic heart disease: An elusive link! J Am Coll Cardiol
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2. Pepine CJ, Douglas PS: Rethinking stable ischemic heart disease: Is this
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3. Patrick W. Serruys, Marie-Claude Morice, A. Pieter Kappetein, Antonio
Colombo, David R. Holmes, Michael J. Mack, et al. Percutaneous Coronary
Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary
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