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...)
(/* ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT){{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 mana...)
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'''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.
'''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>==
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=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). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960 }} </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>===
===Revascularization with PCI and CABG in Asymptomatic Patients (DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=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). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960 }} </ref>===


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{|class="wikitable"
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|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] for patients with significant left main coronary disease. ''(Level of Evidence: B)''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] for patients with significant left main coronary disease. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''2.''' [[CABG]] for patients with three-vessel disease. The survival benefit is greater in patients with abnormal [[LV function]] (ejection fraction less than 50%). ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>
| 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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


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| bgcolor="LightCoral"|'''a.''' only a small area of viable myocardium or
| 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"|'''b.''' no demonstrable [[ischemia]] on noninvasive testing. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''3.''' Use of [[PCI]] or [[CABG]] for patients with insignificant coronary stenosis (less than 50% diameter). ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.''' Use of [[PCI]] in patients with significant left main [[CAD]] who are candidates for [[CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}
   
   
Line 50: Line 50:


|-
|-
| 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>
| 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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 58: Line 58:


|-
|-
| 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>'''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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''2.''' Use of [[PCI]] for patients with significant left main coronary disease who are not candidates for [[CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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>
| 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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Revision as of 23:32, 21 November 2012

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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; 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)[1]

Revascularization with PCI and CABG in Asymptomatic Patients (DO NOT EDIT)[1]

Class I
"1. CABG for patients with significant left main coronary disease. (Level of Evidence: B)"
"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)"
"3. CABG for patients with two-vessel disease with significant proximal left anterior descending CAD and either abnormal LV function (ejection fraction less than 50%) or demonstrable ischemia on noninvasive testing. (Level of Evidence: C)"
"4. PCI for patients with two- or three-vessel disease with significant proximal 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)"
"5. PCI or CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD but with a large area of viable myocardium and high-risk criteria on non-invasive testing. (Level of Evidence: C)"
"6. CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD who have survived sudden cardiac death or sustained ventricular tachycardia. (Level of Evidence: C)"
"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)"
Class III
"1. Use of PCI or CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD and
a. only a small area of viable myocardium or
b. no demonstrable ischemia on noninvasive testing. (Level of Evidence: C)"
"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)"
"3. Use of PCI or CABG for patients with insignificant coronary stenosis (less than 50% diameter). (Level of Evidence: C)"
"4. Use of PCI in patients with significant left main CAD who are candidates for CABG. (Level of Evidence: B)"
Class IIa
"1. PCI or CABG for patients with one-vessel disease with significant proximal left anterior descending CAD. (Level of Evidence: C)"
Class IIb
"1. Compared with CABG, PCI for patients with two or three vessel disease with significant proximal 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)"
"2. Use of PCI for patients with significant left main coronary disease who are not candidates for CABG. (Level of Evidence: C)"
"3. PCI for patients with one or two-vessel CAD without significant proximal left anterior descending CAD who have survived sudden cardiac death or sustained ventricular tachycardia. (Level of Evidence: C)"
"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 LAD. PCI may be appropriate for focal saphenous vein graft lesions or multiple stenoses in poor candidates for reoperative surgery. (Level of Evidence: C)"
"5. PCI or CABG for patients with one- or two-vessel CAD without significant proximal left anterior descending CAD but with a moderate area of viable myocardium and demonstrable ischemia on noninvasive testing. (Level of Evidence: C)"

See Also

Guidelines Resources

  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [2]
  • The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [3]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [4]

References

  1. ↑ 1.0 1.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS; et al. (2003). "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)". J Am Coll Cardiol. 41 (1): 159–68. PMID 12570960.
  2. ↑ Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) 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: 10351980
  3. ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) 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: 12515758
  4. ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) 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. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462

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