Percutaneous coronary intervention non-left main coronary artery disease

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]

Revascularization to Improve Survival in Non-Left Main Coronary Artery Disease (DO NOT EDIT)[1]

Class I
"1.CABG to improve survival is beneficial in patients with significant (≥70% diameter) stenoses in 3 major coronary arteries (with or without involvement of the proximal left anterior descending LAD) or in the proximal LAD plus 1 other major coronary artery.[2][3][4][5][6][7] (Level of Evidence: B)"
"1.CABG or PCI to improve survival is beneficial in survivors of sudden cardiac death with presumed ischemia-mediated ventricular tachycardia caused by significant (≥70% diameter) stenosis in a major coronary artery. (CABG[8][9][10](Level of Evidence: B) ; PCI[11](Level of Evidence: C) "
Class III (Harm)

"1. CABG or PCI should not be performed with the primary or sole intent to improve survival in patients with stable ischemic heart disease with 1 or more coronary stenoses that are not anatomically or functionally significant (e.g., greater than 70% diameter non–left main coronary artery stenosis, fractional flow reserve 0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. [12][13][14][15][16][17][18][19][20](Level of Evidence: B)"

Class IIa

"1.CABG to improve survival is reasonable in patients with significant (≥70% diameter) stenoses in 2 major coronary arteries with severe or extensive myocardial ischemia (eg, high-risk criteria on stress testing, abnormal intracoronary hemodynamic evaluation, or >20% perfusion defect by myocardial perfusion stress imaging) or target vessels supplying a large area of viable myocardium.[21][22][23][24](Level of Evidence: B)"

"2.CABG to improve survival is reasonable in patients with mild-moderate left ventricular systolic dysfunction (ejection fraction 35% to 50%) and significant (≥70% diameter stenosis) multivessel CAD or proximal LAD coronary artery stenosis, when viable myocardium is present in the region of intended revascularization.21,[25][26][27][28][29](Level of Evidence: B)"

"3.CABG with a left internal mammary artery graft to improve survival is reasonable in patients with significant (≥70% diameter) stenosis in the proximal LAD artery and evidence of extensive ischemia.[30][31][32][33](Level of Evidence: B)"

"4.It is reasonable to choose CABG over PCI to improve survival in patients with complex 3-vessel CAD (eg, SYNTAX score >22) with or without involvement of the proximal LAD artery who are good candidates for CABG.[34][35][36][37][38](Level of Evidence: B)"

"5.CABG is probably recommended in preference to PCI to improve survival in patients with multivessel CAD and diabetes mellitus, particularly if a left internal mammary artery graft can be anastomosed to the LAD artery.[39][40][41][42][43][44][45][46][47](Level of Evidence: B)"

Class IIb

"1. The usefulness of CABG to improve survival is uncertain in patients with significant (≥70%) stenoses in 2 major coronary arteries not involving the proximal LAD artery and without extensive ischemia.[48] (Level of Evidence: C)"

"2.The usefulness of PCI to improve survival is uncertain in patients with 2- or 3-vessel CAD (with or without involvement of the proximal LAD artery) or 1-vessel proximal LAD disease.[49][50][51][52] (Level of Evidence: B)"

"3.CABG might be considered with the primary or sole intent of improving survival in patients with SIHD with severe left ventricular systolic dysfunction (ejection fraction <35%) whether or not viable myocardium is present.[53][54][55][56][57][58][59][60](Level of Evidence: B)"

"4.The usefulness of CABG or PCI to improve survival is uncertain in patients with previous CABG and extensive anterior wall ischemia on noninvasive testing.[61][62][63][64][65][66](Level of Evidence: B)"

References

  1. ↑ 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. ↑ Dzavik V, Ghali WA, Norris C, et al. Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the alberta provincial project for outcome assessment in coronary heart disease (approach) investigators. Am Heart J. 2001; 142: 119– 26.
  3. ↑ Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994; 344: 563– 70.
  4. ↑ Jones RH, Kesler K, Phillips HR III., et al. Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease. J Thorac Cardiovasc Surg. 1996; 111: 1013– 25.
  5. ↑ Myers WO, Schaff HV, Gersh BJ, et al. Improved survival of surgically treated patients with triple vessel coronary artery disease and severe angina pectoris. A report from the Coronary Artery Surgery Study (CASS) registry. J Thorac Cardiovasc Surg. 1989; 97: 487– 95. .
  6. ↑ Varnauskas E. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N Engl J Med. 1988; 319: 332– 7.
  7. ↑ Smith PK, Califf RM, Tuttle RH, et al. Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg. 2006; 82: 1420– 8.
  8. ↑ Borger van der Burg AE, Bax JJ, Boersma E, et al. Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital. Am J Cardiol. 2003; 91: 785– 9.
  9. ↑ Every NR, Fahrenbruch CE, Hallstrom AP, et al. Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest. J Am Coll Cardiol. 1992; 19: 1435– 9.
  10. ↑ Kaiser GA, Ghahramani A, Bolooki H, et al. Role of coronary artery surgery in patients surviving unexpected cardiac arrest. Surgery. 1975; 78: 749– 54.
  11. ↑ Borger van der Burg AE, Bax JJ, Boersma E, et al. Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after non fatal cardiac arrest outside the hospital. Am J Cardiol. 2003; 91: 785– 9.
  12. ↑ Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R (1994). "Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration". Lancet. 344 (8922): 563–70. PMID 7914958. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  13. ↑ Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM (1996). "Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease". The Journal of Thoracic and Cardiovascular Surgery. 111 (5): 1013–25. PMID 8622299. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  14. ↑ Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, Fromm B (1998). "Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions". The Journal of Thoracic and Cardiovascular Surgery. 116 (6): 997–1004. PMID 9832692. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  15. ↑ Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003). "Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography". Circulation. 107 (23): 2900–7. doi:10.1161/01.CIR.0000072790.23090.41. PMID 12771008. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  16. ↑ Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, Weintraub WS, O'Rourke RA, Dada M, Spertus JA, Chaitman BR, Friedman J, Slomka P, Heller GV, Germano G, Gosselin G, Berger P, Kostuk WJ, Schwartz RG, Knudtson M, Veledar E, Bates ER, McCallister B, Teo KK, Boden WE (2008). "Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy". Circulation. 117 (10): 1283–91. doi:10.1161/CIRCULATIONAHA.107.743963. PMID 18268144. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  17. ↑ Cashin WL, Sanmarco ME, Nessim SA, Blankenhorn DH (1984). "Accelerated progression of atherosclerosis in coronary vessels with minimal lesions that are bypassed". The New England Journal of Medicine. 311 (13): 824–8. doi:10.1056/NEJM198409273111304. PMID 6332274. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  18. ↑ Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, Koolen JJ (1996). "Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses". The New England Journal of Medicine. 334 (26): 1703–8. doi:10.1056/NEJM199606273342604. PMID 8637515. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  19. ↑ Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF (2009). "Fractional flow reserve versus angiography for guiding percutaneous coronary intervention". The New England Journal of Medicine. 360 (3): 213–24. doi:10.1056/NEJMoa0807611. PMID 19144937. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  20. ↑ Sawada S, Bapat A, Vaz D, Weksler J, Fineberg N, Greene A, Gradus-Pizlo I, Feigenbaum H (2003). "Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction". Journal of the American College of Cardiology. 42 (12): 2099–105. PMID 14680734. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  21. ↑ Di Carli MF, Maddahi J, Rokhsar S, et al. Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg. 1998; 116: 997– 1004.
  22. ↑ Hachamovitch R, Hayes SW, Friedman JD, et al. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003; 107: 2900– 7.
  23. ↑ Sorajja P, Chareonthaitawee P, Rajagopalan N, et al. Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting. Circulation. 2005; 112: I311– 6.
  24. ↑ Davies RF, Goldberg AD, Forman S, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: outcomes of patients randomized to initial strategies of medical therapy versus revascularization. Circulation. 1997; 95: 2037– 43.
  25. ↑ Alderman EL, Fisher LD, Litwin P, et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983; 68: 785– 95.
  26. ↑ O'Connor CM, Velazquez EJ, Gardner LH, et al. Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank). Am J Cardiol. 2002; 90: 101– 7.
  27. ↑ Phillips HR, O'Connor CM, Rogers J. Revascularization for heart failure. Am Heart J. 2007; 153: 65– 73.
  28. ↑ Tarakji KG, Brunken R, McCarthy PM, et al. Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction. Circulation. 2006; 113: 230– 7.
  29. ↑ Tsuyuki RT, Shrive FM, Galbraith PD, et al. Revascularization in patients with heart failure. CMAJ. 2006; 175: 361– 5.
  30. ↑ Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994; 344: 563– 70.
  31. ↑ Smith PK, Califf RM, Tuttle RH, et al. Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg. 2006; 82: 1420– 8.
  32. ↑ Cameron A, Davis KB, Green G, et al. Coronary bypass surgery with internal-thoracic-artery grafts—effects on survival over a 15-year period. N Engl J Med. 1996; 334: 216– 9.
  33. ↑ Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986; 314: 1– 6.
  34. ↑ Hannan EL, Wu C, Walford G, et al. Drug-eluting stents vs coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008; 358: 331– 41.
  35. ↑ Kappetein AP, Mohr FW, Feldman TE, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J. 2011; 17: 2125– 34.
  36. ↑ Smith PK, Califf RM, Tuttle RH, et al. Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg. 2006; 82: 1420– 8.
  37. ↑ Brener SJ, Lytle BW, Casserly IP, et al. Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features. Circulation. 2004; 109: 2290– 5.
  38. ↑ Hannan EL, Racz MJ, Walford G, et al. Long-term outcomes of coronary-artery bypass grafting versus stent implantation. N Engl J Med. 2005; 352: 2174– 83.
  39. ↑ Sorajja P, Chareonthaitawee P, Rajagopalan N, et al. Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting. Circulation. 2005; 112: I311– 6.
  40. ↑ The BARI Investigators. Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI). Circulation. 1997; 96: 1761– 9.
  41. ↑ The BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol. 2007; 49: 1600– 6.
  42. ↑ Banning AP, Westaby S, Morice MC, et al. Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol. 2010; 55: 1067– 75.
  43. ↑ Hoffman SN, TenBrook JA, Wolf MP, et al. A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes. J Am Coll Cardiol. 2003; 41: 1293– 304.
  44. ↑ Hueb W, Lopes NH, Gersh BJ, et al. Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation. 2007; 115: 1082– 9.
  45. ↑ Malenka DJ, Leavitt BJ, Hearne MJ, et al. Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. Circulation. 2005; 112: I371– 6.
  46. ↑ Niles NW, McGrath PD, Malenka D, et al., Northern New England Cardiovascular Disease Study Group. Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. J Am Coll Cardiol. 2001; 37: 1008– 15.
  47. ↑ Weintraub WS, Stein B, Kosinski A, et al. Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease. J Am Coll Cardiol. 1998; 31: 10– 9.
  48. ↑ Smith PK, Califf RM, Tuttle RH, et al. Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg. 2006; 82: 1420– 8
  49. ↑ Dzavik V, Ghali WA, Norris C, et al. Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the alberta provincial project for outcome assessment in coronary heart disease (approach) investigators. Am Heart J. 2001; 142: 119– 26.
  50. ↑ Jones RH, Kesler K, Phillips HR III., et al. Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease. J Thorac Cardiovasc Surg. 1996; 111: 1013– 25.
  51. ↑ Smith PK, Califf RM, Tuttle RH, et al. Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg. 2006; 82: 1420– 8.
  52. ↑ Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356: 1503– 16.
  53. ↑ Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994; 344: 563– 70.
  54. ↑ Alderman EL, Fisher LD, Litwin P, et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983; 68: 785– 95.
  55. ↑ O'Connor CM, Velazquez EJ, Gardner LH, et al. Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank). Am J Cardiol. 2002; 90: 101– 7.
  56. ↑ Phillips HR, O'Connor CM, Rogers J. Revascularization for heart failure. Am Heart J. 2007; 153: 65– 73.
  57. ↑ Tarakji KG, Brunken R, McCarthy PM, et al. Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction. Circulation. 2006; 113: 230– 7.
  58. ↑ Tsuyuki RT, Shrive FM, Galbraith PD, et al. Revascularization in patients with heart failure. CMAJ. 2006; 175: 361– 5.
  59. ↑ Bonow RO, Maurer G, Lee KL, et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011; 364: 1617– 25.
  60. ↑ Velazquez EJ, Lee KL, Deja MA, et al. Coronary artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med. 2011; 364: 1607– 16.
  61. ↑ Brener SJ, Lytle BW, Casserly IP, et al. Predictors of revascularization method and long-term outcome of percutaneous coronary intervention or repeat coronary bypass surgery in patients with multivessel coronary disease and previous coronary bypass surgery. Eur Heart J. 2006; 27: 413– 8.
  62. ↑ Gurfinkel EP, Perez de la Hoz R, Brito VM, et al. Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery. Int J Cardiol. 2007; 119: 65– 72.
  63. ↑ Lytle BW, Loop FD, Taylor PC, et al. The effect of coronary reoperation on the survival of patients with stenoses in saphenousvein bypass grafts to coronary arteries. J Thorac Cardiovasc Surg. 1993; 105: 605– 12.
  64. ↑ Morrison DA, Sethi G, Sacks J, et al. Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. Investigators of the Department of Veterans Affairs Cooperative Study #385, the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME). J Am Coll Cardiol. 2001; 38: 143– 9.
  65. ↑ Pfautsch P, Frantz E, Ellmer A, et al. [Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization]. Z Kardiol. 1999; 88: 489– 97.
  66. ↑ Sergeant P, Blackstone E, Meyns B, et al. First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting. Eur J Cardiothorac Surg. 1998; 14: 480– 7.

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