Chronic stable angina revascularization with PCI and CABG in asymptomatic patients: Difference between revisions

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(/* ACC/AHA Guidelines- Recommendations for Revascularization with PCI and CABG in Asymptomatic Patients (DO NOT EDIT)Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)guidelines for the management of patients with chro...)
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{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]];  Smita Kohli, M.D.


==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>==
===Revascularization with PCI and CABG in Asymptomatic Patients (DO NOT EDIT)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] for patients with significant left main coronary disease. ''(Level of Evidence: B)''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[CABG]] for patients with three-vessel disease. The survival benefit is greater in patients with abnormal [[LV function]] (ejection fraction less than 50%). ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[CABG]] for patients with two-vessel disease with significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] and either abnormal [[LV function]] (ejection fraction less than 50%) or demonstrable [[ischemia]] on noninvasive testing. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' [[PCI]] for patients with two- or three-vessel disease with significant proximal [[left anterior descending artery|Left anterior descending]] [[CAD]] who have anatomy suitable for catheter based therapy and normal [[LV function]] and who do not have treated [[diabetes]]. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' [[PCI]] or [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] but with a large area of viable myocardium and high-risk criteria on non-invasive testing. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] who have survived sudden cardiac death or sustained [[ventricular tachycardia]]. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' In patients with prior [[PCI]], [[CABG]] or [[PCI]] for recurrent stenosis associated with a large area of viable myocardium or high-risk criteria on noninvasive testing. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Use of [[PCI]] or [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] and
|-
| bgcolor="LightCoral"|'''a.''' only a small area of viable myocardium or
|-
| bgcolor="LightCoral"|'''b.''' no demonstrable [[ischemia]] on noninvasive testing. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Use of [[PCI]] or [[CABG]] for patients with borderline coronary stenoses (50% to 60% diameter in locations other than the left main coronary artery) and no demonstrable [[ischemia]] on noninvasive testing. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' Use of [[PCI]] or [[CABG]] for patients with insignificant coronary stenosis (less than 50% diameter). ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.''' Use of [[PCI]] in patients with significant left main [[CAD]] who are candidates for [[CABG]]. ''(Level of Evidence: B)''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[PCI]] or [[CABG]] for patients with one-vessel disease with significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]]. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Compared with [[CABG]], [[PCI]] for patients with two or three vessel disease with significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] who have anatomy suitable for catheter-based therapy and who have treated [[diabetes]] or abnormal [[LV function]]. ''(Level of Evidence: B)''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Use of [[PCI]] for patients with significant left main coronary disease who are not candidates for [[CABG]]. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' [[PCI]] for patients with one or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] who have survived sudden cardiac death or sustained ventricular tachycardia. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' Repeat [[CABG]] for patients with multiple saphenous vein graft stenoses, with high-risk criteria on noninvasive testing, especially when there is significant stenosis of a graft supplying the [[left anterior descending artery|LAD]]. [[PCI]] may be appropriate for focal saphenous vein graft lesions or multiple stenoses in poor candidates for reoperative surgery. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' [[PCI]] or [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] but with a moderate area of viable myocardium and demonstrable [[ischemia]] on noninvasive testing. ''(Level of Evidence: C)''<nowiki>"</nowiki>
|}
==See Also==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
==Guidelines Resources==
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>
*The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</ref>
==References==
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Latest revision as of 16:40, 4 December 2012