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©2013 UpToDate ® Print Email ACC/AHA Guideline Summary: Coronary artery bypass graft surgery (CABG) in patients with asymptomatic ischemia or mild angina Class I - There is evidenceand/or general agreement that CABG should be performed in patients withasymptomatic ischemia or mild angina in the following settings •  Significant left main coronary artery disease. •  Significant left main equivalent disease, which is defined as ≥70 percent stenosis of the proximal left anterior descending (LAD) and proximal left circumflex arteries. •  Three-vessel disease; the survival benefit is greater with a reduced left ventricular ejection fraction (less than 50 percent) and/or a large area of myocardium at risk on noninvasive testing. •  Significant proximalLAD disease with one- or two-vessel disease with a reduced leftventricular ejection fraction (less than 50 percent) and/or a largearea of myocardium at risk on noninvasive testing. •  One or two-vessel disease not involving the proximal LAD with a large area of myocardium at risk and high-risk criteria on noninvasive testing. Class IIa - The weight ofevidence or opinion is in favor of benefit from CABG in patients withasymptomatic ischemia or mild angina in the following setting •  Significant proximal LAD disease with one- or two-vessel disease in the absence of the above high-risk features. Class IIb - The evidence oropinion is less well established for the use of CABG in patients withasymptomatic ischemia or mild angina in the following setting •  One or two-vessel disease not involving the proximal LAD in the absence of the above high-risk features. Data from: Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004; 110:e340.