Chronic stable angina revascularization percutaneous coronary intervention indications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) (DO NOT EDIT)[1]

Asymptomatic Ischemia or CCS Class I or II Angina (DO NOT EDIT)[1]

Class III
"1. PCI is not recommended in patients with asymptomatic ischemia or CCS class I or II angina who do not meet the criteria as listed under the class II recommendations or who have 1 or more of the following:
a. Only a small area of viable myocardium at risk. (Level of Evidence: C)
b. No objective evidence of ischemia. (Level of Evidence: C)
c. Lesions that have a low likelihood of successful dilatation. (Level of Evidence: C)
d. Mild symptoms that are unlikely to be due to myocardial ischemia. (Level of Evidence: C)
e. Factors associated with increased risk of morbidity or mortality. (Level of Evidence: C)
f. Left main disease and eligibility for CABG. (Level of Evidence: C)
g. Insignificant disease (less than 50% coronary stenosis). (Level of Evidence: C)"
Class IIa

"1. PCI is reasonable in patients with asymptomatic ischemia or CCS class I or II angina and with 1 or more significant lesions in 1 or 2 coronary arteries suitable for PCI with a high likelihood of success and a low risk of morbidity and mortality. The vessels to be dilated must subtend a moderate to large area of viable myocardium or be associated with a moderate to severe degree of ischemia on noninvasive testing. (Level of Evidence: B)"

"2. PCI is reasonable for patients with asymptomatic ischemia or CCS class I or II angina, and recurrent stenosis after PCI with a large area of viable myocardium or high-risk criteria on noninvasive testing. (Level of Evidence: C)"

"3. Use of PCI is reasonable in patients with asymptomatic ischemia or CCS class I or II angina with significant left main CAD (greater than 50% diameterstenosis) who are candidates for revascularization but are not eligible for CABG. (Level of Evidence: B)"

Class IIb

"1. The effectiveness of PCI for patients with asymptomatic ischemia or CCS class I or II angina who have 2- or 3-vessel disease with significantproximal LAD CAD who are otherwise eligible for CABGwith 1 arterial conduit and who have treated diabetes or abnormal LV function is not well established. (Level of Evidence: B)"

"2. PCI might be considered for patients with asymptomatic ischemia or CCS class I or II angina with non-proximal LAD CAD that subtends a moderate area of viable myocardium and demonstrates ischemia on noninvasive testing. (Level of Evidence: C)"

CCS Class III Angina (DO NOT EDIT)[1]

Class III

"1. PCI is not recommended for patients with CCS class III angina with single-vessel or multivessel CAD, no evidence of myocardial injury or ischemia on objective testing, and no trial of medical therapy, or who have 1 of the following:

a. Only a small area of myocardium at risk. (Level of Evidence: C)
b. All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. (Level of Evidence: C)
c. A high risk of procedure-related morbidity or mortality. (Level of Evidence: C)
d. Insignificant disease (less than 50% coronary stenosis). (Level of Evidence: C)
e. Significant left main CAD and candidacy for CABG. (Level of Evidence: C)"
Class IIa

"1. It is reasonable that PCI be performed in patients with CCS class III angina and single-vessel or multi-vessel CAD who are undergoing medical therapy and who have 1 or more significant lesions in 1 or more coronary arteries suitable for PCI with a high likelihood of success and low risk of morbidity or mortality. (Level of Evidence: B)"

"2. It is reasonable that PCI be performed in patients with CCS class III angina with single-vessel or multi-vessel CAD who are undergoing medical therapy with focal saphenous vein graft lesions or multiple stenoses who are poor candidates for reoperative surgery. (Level of Evidence: C)"

"3. Use of PCI is reasonable in patients with CCS class III angina with significant left main CAD(greater than 50% diameter stenosis) who are candidates for revascularization but are not eligible for CABG. (Level of Evidence: B)"

Class IIb

"1. PCI may be considered in patients with CCS class III angina with single-vessel or multivessel CAD who are undergoing medical therapy and who have 1 or more lesions to be dilated with a reduced likelihood of success. (Level of Evidence: B)"

"2. PCI may be considered in patients with CCS class III angina and no evidence of ischemia on noninvasive testing or who are undergoing medical therapy and have 2- or 3-vessel CAD with significant proximal LAD CAD and treated diabetes or abnormal LV function. (Level of Evidence: B)"

References

  1. 1.0 1.1 1.2 Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO (2009). "2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Journal of the American College of Cardiology. 54 (23): 2205–41. doi:10.1016/j.jacc.2009.10.015. PMID 19942100. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)

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