B. Unstable Angina
Patients with unstable angina are identified by the follow¬ing: a change in pattern, increasing frequency, severity and/or duration of pain, and a lesser degree of known precipitating factors. Pain may occur on exertion and at rest. Also, new onset of angina present for less than 60 days is classified as unstable angina.
The majority of patients with unstable angina should undergo coronary arteriography. Depending on the extent and site of lesions, they are offered PCI or surgery if no major contraindication exists.
C. Left Main Coronary Artery Disease
The left main coronary artery is a short segment before it divides into the LAD and circumflex arteries (see Fig. 2). Severe disease of the left main is fortunately uncommon but is obviously a serious situation when it occurs, because it supplies blood to most of the heart. Thus, CABG is advisable regardless of the severity of symptoms or left ventricular dysfunction. Patients with triple-vessel disease which includes atheromatous obstruction of the proximal LAD are at high risk for coronary events and bypass surgery is usually recommended.
D. Diabetes Mellitus
Patients with diabetes and stable or unstable angina with triple- or double-vessel disease, especially if this involves the LAD, are usually offered surgery because its benefits supersede those of PCI.

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