Percutaneous coronary intervention (PCI): Difference between revisions

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(/* 2011 ACCF/AHA/SCAI Guideline Recommendations: PCI in Specific Patient Population {{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Maur...)
 
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__NOTOC__
#redirect[[Percutaneous coronary intervention: basic principles and guidelines]]
{{Template:Percutaneous Coronary Intervention}}
 
'''For patient information click [[Angioplasty (patient information)|here]]'''
 
{{CMG}}; {{AOEIC}} {{LG}}
 
{{SK}} PCI; balloon angioplasty; percutaneous transluminal angioplasty
 
==Overview==
'''Percutaneous coronary intervention''' ('''PCI'''), commonly known as '''coronary angioplasty''', is an invasive [[Cardiology|cardiologic]] therapeutic procedure to treat the [[stenosis|stenotic]] (narrowed) [[coronary artery|coronary arteries]] of the [[heart]].  These stenotic segments are due to the build up of [[cholesterol]]-laden plaques that form due to [[coronary heart disease]].
 
Percutaneous coronary intervention can be performed to reduce or eliminate the symptoms of coronary artery disease, including [[angina pectoris|angina]] (chest pain), dyspnea (shortness of breath) on exertion, and [[congestive heart failure]].  PCI is also used to abort an acute [[myocardial infarction]], and in some specific cases it may reduce [[death|mortality]].
 
==Epidemiology and Demographics==
* Approximately 850,000 PCIs are performed each year in the United States.
 
===ACCF/AHA Guidelines for Revascularization to Improve Survival: Left Main Coronary Artery Disease<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
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<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve survival should not be performed in [[chronic stable angina definition|stable]] patients with significant (greater than or equal to 50% diameter [[stenosis]]) [[PCI in the unprotected left main patient|unprotected left main CAD]] who have unfavorable anatomy for [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] and who are good candidates for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. <ref name="pmid21256999">Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21256999 Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization.] ''Am J Cardiol'' 107 (3):360-6. [http://dx.doi.org/10.1016/j.amjcard.2010.09.029 DOI:10.1016/j.amjcard.2010.09.029] PMID:[http://pubmed.gov/21256999 21256999]</ref><ref name="pmid20630454">Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630454 Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization.] ''JACC Cardiovasc Interv'' 3 (6):612-23.[http://dx.doi.org/10.1016/j.jcin.2010.04.004 DOI:10.1016/j.jcin.2010.04.004] PMID:[http://pubmed.gov/20630454 20630454]</ref><ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID:[http://pubmed.gov/20530001 20530001]</ref><ref name="pmid7729018">Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7729018 Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience.] ''Circulation'' 91 (9):2325-34. PMID: [http://pubmed.gov/7729018 7729018]</ref><ref name="pmid7025604">Chaitman BR, Fisher LD, Bourassa MG, Davis K, Rogers WJ, Maynard C et al. (1981)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7025604 Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS).] ''Am J Cardiol'' 48 (4):765-77. PMID:[http://pubmed.gov/7025604 7025604]</ref><ref name="pmid11431667">Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD et al. (2001)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11431667 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''142 (1):119-26. [http://dx.doi.org/10.1067/mhj.2001.116072 DOI:10.1067/mhj.2001.116072] PMID:[http://pubmed.gov/11431667 11431667]</ref><ref name="pmid791537">Takaro T, Hultgren HN, Lipton MJ, Detre KM (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=791537 The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions.]''Circulation'' 54 (6 Suppl):III107-17. PMID: [http://pubmed.gov/791537 791537]</ref><ref name="pmid6979435">Takaro T, Peduzzi P, Detre KM, Hultgren HN, Murphy ML, van der Bel-Kahn J et al. (1982) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6979435 Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease.] ''Circulation'' 66 (1):14-22. PMID: [http://pubmed.gov/69794356979435]</ref><ref name="pmid2785870">Taylor HA, Deumite NJ, Chaitman BR, Davis KB, Killip T, Rogers WJ (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2785870 Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry.] ''Circulation'' 79 (6):1171-9. PMID:[http://pubmed.gov/2785870 2785870]</ref><ref name="pmid7914958">Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW et al. (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7914958 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: [http://pubmed.gov/79149587914958]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve survival is reasonable as an alternative to [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] in selected [[chronic stable angina|stable]] patients with significant (greater than or equal to 50% diameter stenosis) [[PCI in the unprotected left main patient|unprotected left main CAD]] with:
 
:'''a.''' Anatomic conditions associated with a low risk of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] procedural complications and a high likelihood of good long-term outcome (e.g., a low [[SYNTAX]] score [lower than or equal to 22], ostial or trunk [[left main]] [[CAD]]); and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' Clinical characteristics that predict a significantly increased risk of adverse surgical outcomes (e.g., Society of Thoracic Surgeons–predicted risk of operative mortality 5%). <ref name="pmid21256999">Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21256999 Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization.] ''Am J Cardiol'' 107 (3):360-6. [http://dx.doi.org/10.1016/j.amjcard.2010.09.029 DOI:10.1016/j.amjcard.2010.09.029] PMID:[http://pubmed.gov/21256999 21256999]</ref><ref name="pmid20630454">Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630454 Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization.] ''JACC Cardiovasc Interv'' 3 (6):612-23.[http://dx.doi.org/10.1016/j.jcin.2010.04.004 DOI:10.1016/j.jcin.2010.04.004] PMID:[http://pubmed.gov/20630454 20630454]</ref><ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID:[http://pubmed.gov/20530001 20530001]</ref><ref name="pmid21697170">Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21697170 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'' 32 (17):2125-34. [http://dx.doi.org/10.1093/eurheartj/ehr213DOI:10.1093/eurheartj/ehr213] PMID: [http://pubmed.gov/21697170 21697170]</ref><ref name="pmid21435606">Capodanno D, Caggegi A, Miano M, Cincotta G, Dipasqua F, Giacchi G et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21435606 Global risk classification and clinical SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score in patients undergoing percutaneous or surgical left main revascularization.] ''JACC Cardiovasc Interv'' 4 (3):287-97. [http://dx.doi.org/10.1016/j.jcin.2010.10.013 DOI:10.1016/j.jcin.2010.10.013]PMID: [http://pubmed.gov/21435606 21435606]</ref><ref name="pmid18216353">Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18216353 Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.] ''N Engl J Med'' 358 (4):331-41.[http://dx.doi.org/10.1056/NEJMoa071804 DOI:10.1056/NEJMoa071804] PMID: [http://pubmed.gov/1821635318216353]</ref><ref name="pmid9403609">Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9403609 Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.]''Circulation'' 96 (11):3867-72. PMID: [http://pubmed.gov/9403609 9403609]</ref><ref name="pmid18215597">Biondi-Zoccai GG, Lotrionte M, Moretti C, Meliga E, Agostoni P, Valgimigli M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18215597 A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease.] ''Am Heart J'' 155 (2):274-83.[http://dx.doi.org/10.1016/j.ahj.2007.10.009 DOI:10.1016/j.ahj.2007.10.009] PMID:[http://pubmed.gov/18215597 18215597]</ref><ref name="pmid21272743">Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21272743 Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis.] ''J Am Coll Cardiol'' 57 (5):538-45.[http://dx.doi.org/10.1016/j.jacc.2010.09.038 DOI:10.1016/j.jacc.2010.09.038] PMID:[http://pubmed.gov/21272743 21272743]</ref><ref name="pmid18178401">Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18178401 Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients.] ''Am J Cardiol'' 101 (2):169-72. [http://dx.doi.org/10.1016/j.amjcard.2007.08.054DOI:10.1016/j.amjcard.2007.08.054] PMID: [http://pubmed.gov/18178401 18178401]</ref><ref name="pmid18237682">Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18237682 Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization.] ''J Am Coll Cardiol'' 51 (5):538-45.[http://dx.doi.org/10.1016/j.jacc.2007.09.054 DOI:10.1016/j.jacc.2007.09.054] PMID:[http://pubmed.gov/18237682 18237682]</ref><ref name="pmid16717151">Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M et al. (2006)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16717151 Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.]''Circulation'' 113 (21):2542-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595694DOI:10.1161/CIRCULATIONAHA.105.595694] PMID: [http://pubmed.gov/16717151 16717151]</ref><ref name="pmid16487857">Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. (2006)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16487857 Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.] ''J Am Coll Cardiol'' 47 (4):864-70. [http://dx.doi.org/10.1016/j.jacc.2005.09.072DOI:10.1016/j.jacc.2005.09.072] PMID: [http://pubmed.gov/16487857 16487857]</ref><ref name="pmid18608116">Mäkikallio TH, Niemelä M, Kervinen K, Jokinen V, Laukkanen J, Ylitalo I et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18608116 Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting.] ''Ann Med'' 40 (6):437-43. [http://dx.doi.org/10.1080/07853890701879790 DOI:10.1080/07853890701879790]PMID: [http://pubmed.gov/18608116 18608116]</ref><ref name="pmid19695542">Naik H, White AJ, Chakravarty T, Forrester J, Fontana G, Kar S et al. (2009)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19695542 A meta-analysis of 3,773 patients treated with percutaneous coronary intervention or surgery for unprotected left main coronary artery stenosis.]''JACC Cardiovasc Interv'' 2 (8):739-47. [http://dx.doi.org/10.1016/j.jcin.2009.05.020DOI:10.1016/j.jcin.2009.05.020] PMID: [http://pubmed.gov/19695542 19695542]</ref><ref name="pmid16784920">Palmerini T, Marzocchi A, Marrozzini C, Ortolani P, Saia F, Savini C et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16784920 Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry).] ''Am J Cardiol'' 98 (1):54-9.[http://dx.doi.org/10.1016/j.amjcard.2006.01.070 DOI:10.1016/j.amjcard.2006.01.070] PMID:[http://pubmed.gov/16784920 16784920]</ref><ref name="pmid20451344">Park DW, Seung KB, Kim YH, Lee JY, Kim WJ, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20451344 Long-term safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 5-year results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry.] ''J Am Coll Cardiol'' 56 (2):117-24. [http://dx.doi.org/10.1016/j.jacc.2010.04.004DOI:10.1016/j.jacc.2010.04.004] PMID: [http://pubmed.gov/20451344 20451344]</ref><ref name="pmid19029471">Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19029471 Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.] ''Circulation'' 118 (23):2374-81.[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.727099 DOI:10.1161/CIRCULATIONAHA.107.727099] PMID:[http://pubmed.gov/19029471 19029471]</ref><ref name="pmid17826380">Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17826380 Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease.] ''Am J Cardiol'' 100 (6):970-3.[http://dx.doi.org/10.1016/j.amjcard.2007.04.037 DOI:10.1016/j.amjcard.2007.04.037] PMID:[http://pubmed.gov/17826380 17826380]</ref><ref name="pmid18378517">Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18378517 Stents versus coronary-artery bypass grafting for left main coronary artery disease.] ''N Engl J Med'' 358 (17):1781-92.[http://dx.doi.org/10.1056/NEJMoa0801441 DOI:10.1056/NEJMoa0801441] PMID:[http://pubmed.gov/18378517 18378517]</ref><ref name="pmid19463306">White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19463306 Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis.]''JACC Cardiovasc Interv'' 1 (3):236-45. [http://dx.doi.org/10.1016/j.jcin.2008.02.007DOI:10.1016/j.jcin.2008.02.007] PMID: [http://pubmed.gov/19463306 19463306]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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<nowiki>"</nowiki>'''2.''' [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]] to improve survival is reasonable in patients with [[UA|UA/NSTEMI]] when an [[PCI in the unprotected left main patient|unprotected left main coronary artery]] is the culprit lesion and the patient is not a candidate for [[Unstable angina / non ST elevation myocardial infarction recommendations for CABG|CABG]]. <ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID:[http://pubmed.gov/20530001 20530001]</ref><ref name="pmid18178401">Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18178401 Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients.] ''Am J Cardiol'' 101 (2):169-72. [http://dx.doi.org/10.1016/j.amjcard.2007.08.054DOI:10.1016/j.amjcard.2007.08.054] PMID: [http://pubmed.gov/18178401 18178401]</ref><ref name="pmid20630452">Chieffo A, Magni V, Latib A, Maisano F, Ielasi A, Montorfano M et al. (2010)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630452 5-year outcomes following percutaneous coronary intervention with drug-eluting stent implantation versus coronary artery bypass graft for unprotected left main coronary artery lesions the Milan experience.] ''JACC Cardiovasc Interv'' 3 (6):595-601. [http://dx.doi.org/10.1016/j.jcin.2010.03.014 DOI:10.1016/j.jcin.2010.03.014] PMID:[http://pubmed.gov/20630452 20630452]</ref><ref name="pmid16717151">Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M et al. (2006)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16717151 Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.]''Circulation'' 113 (21):2542-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595694DOI:10.1161/CIRCULATIONAHA.105.595694] PMID: [http://pubmed.gov/16717151 16717151]</ref><ref name="pmid16487857">Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. (2006)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16487857 Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.] ''J Am Coll Cardiol'' 47 (4):864-70. [http://dx.doi.org/10.1016/j.jacc.2005.09.072DOI:10.1016/j.jacc.2005.09.072] PMID: [http://pubmed.gov/16487857 16487857]</ref><ref name="pmid19029471">Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19029471 Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.] ''Circulation'' 118 (23):2374-81.[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.727099 DOI:10.1161/CIRCULATIONAHA.107.727099] PMID:[http://pubmed.gov/19029471 19029471]</ref><ref name="pmid17826380">Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17826380 Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease.] ''Am J Cardiol'' 100 (6):970-3.[http://dx.doi.org/10.1016/j.amjcard.2007.04.037 DOI:10.1016/j.amjcard.2007.04.037] PMID:[http://pubmed.gov/17826380 17826380]</ref><ref name="pmid18378517">Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18378517 Stents versus coronary-artery bypass grafting for left main coronary artery disease.] ''N Engl J Med'' 358 (17):1781-92.[http://dx.doi.org/10.1056/NEJMoa0801441 DOI:10.1056/NEJMoa0801441] PMID:[http://pubmed.gov/18378517 18378517]</ref><ref name="pmid19463306">White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19463306 Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis.]''JACC Cardiovasc Interv'' 1 (3):236-45. [http://dx.doi.org/10.1016/j.jcin.2008.02.007DOI:10.1016/j.jcin.2008.02.007] PMID: [http://pubmed.gov/19463306 19463306]</ref><ref name="pmid19720640">Montalescot G, Brieger D, Eagle KA, Anderson FA, FitzGerald G, Lee MS et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19720640 Unprotected left main revascularization in patients with acute coronary syndromes.] ''Eur Heart J'' 30 (19):2308-17.[http://dx.doi.org/10.1093/eurheartj/ehp353 DOI:10.1093/eurheartj/ehp353] PMID:[http://pubmed.gov/19720640 19720640]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] to improve survival is reasonable in patients with [[STEMI|acute STEMI]] when an [[PCI in the unprotected left main patient|unprotected left main coronary artery]] is the culprit lesion, distal coronary flow is less than TIMI (Thrombolysis In Myocardial Infarction) [[TIMI flow grade|grade 3]], and [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] can be performed more rapidly and safely than [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. <ref name="pmid9403609">Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9403609 Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.]''Circulation'' 96 (11):3867-72. PMID: [http://pubmed.gov/9403609 9403609]</ref><ref name="pmid18573394">Lee MS, Tseng CH, Barker CM, Menon V, Steckman D, Shemin R et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18573394 Outcome after surgery and percutaneous intervention for cardiogenic shock and left main disease.] ''Ann Thorac Surg'' 86 (1):29-34.[http://dx.doi.org/10.1016/j.athoracsur.2008.03.019 DOI:10.1016/j.athoracsur.2008.03.019] PMID:[http://pubmed.gov/18573394 18573394]</ref><ref name="pmid20723848">Lee MS, Bokhoor P, Park SJ, Kim YH, Stone GW, Sheiban I et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20723848 Unprotected left main coronary disease and ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention.] ''JACC Cardiovasc Interv'' 3 (8):791-5.[http://dx.doi.org/10.1016/j.jcin.2010.06.005 DOI:10.1016/j.jcin.2010.06.005] PMID:[http://pubmed.gov/20723848 20723848]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
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|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve survival may be reasonable as an alternative to [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] in selected [[chronic stable angina definition|stable]]patients with significant (greater than or equal to 50% diameter [[stenosis]]) [[PCI in the unprotected left main patient|unprotected left main CAD]] with:
 
:'''a.''' Anatomic conditions associated with a low to intermediate risk of [[Chronic stable angina revascularization complications of percutaneous coronary intervention|PCI procedural complications]]and an intermediate to high likelihood of good long-term outcome (e.g., low-intermediate[[SYNTAX|SYNTAX score]] of lower than 33, bifurcation [[left main]] [[CAD]]); and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' Clinical characteristics that predict an increased risk of adverse surgical outcomes (e.g., moderate-severe [[COPD|chronic obstructive pulmonary disease]], [[Stroke rehabilitation|disability from previous stroke]], or previous cardiac surgery; Society of Thoracic Surgeons–predicted risk of operative mortality greater than 2%). <ref name="pmid21256999">Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21256999 Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization.] ''Am J Cardiol'' 107 (3):360-6. [http://dx.doi.org/10.1016/j.amjcard.2010.09.029 DOI:10.1016/j.amjcard.2010.09.029] PMID:[http://pubmed.gov/21256999 21256999]</ref><ref name="pmid20630454">Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630454 Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization.] ''JACC Cardiovasc Interv'' 3 (6):612-23.[http://dx.doi.org/10.1016/j.jcin.2010.04.004 DOI:10.1016/j.jcin.2010.04.004] PMID:[http://pubmed.gov/20630454 20630454]</ref><ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID:[http://pubmed.gov/20530001 20530001]</ref><ref name="pmid21697170">Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21697170 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'' 32 (17):2125-34.[http://dx.doi.org/10.1093/eurheartj/ehr213DOI:10.1093/eurheartj/ehr213] PMID:[http://pubmed.gov/21697170 21697170]</ref><ref name="pmid21435606">Capodanno D, Caggegi A, Miano M, Cincotta G, Dipasqua F, Giacchi G et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21435606 Global risk classification and clinical SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score in patients undergoing percutaneous or surgical left main revascularization.] ''JACC Cardiovasc Interv'' 4 (3):287-97. [http://dx.doi.org/10.1016/j.jcin.2010.10.013 DOI:10.1016/j.jcin.2010.10.013]PMID: [http://pubmed.gov/21435606 21435606]</ref><ref name="pmid18216353">Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18216353 Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.] ''N Engl J Med'' 358 (4):331-41.[http://dx.doi.org/10.1056/NEJMoa071804 DOI:10.1056/NEJMoa071804] PMID: [http://pubmed.gov/1821635318216353]</ref><ref name="pmid9403609">Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9403609 Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.]''Circulation'' 96 (11):3867-72. PMID: [http://pubmed.gov/9403609 9403609]</ref><ref name="pmid18215597">Biondi-Zoccai GG, Lotrionte M, Moretti C, Meliga E, Agostoni P, Valgimigli M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18215597 A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease.] ''Am Heart J'' 155 (2):274-83.[http://dx.doi.org/10.1016/j.ahj.2007.10.009 DOI:10.1016/j.ahj.2007.10.009] PMID:[http://pubmed.gov/18215597 18215597]</ref><ref name="pmid21272743">Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21272743 Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis.] ''J Am Coll Cardiol'' 57 (5):538-45.[http://dx.doi.org/10.1016/j.jacc.2010.09.038 DOI:10.1016/j.jacc.2010.09.038] PMID:[http://pubmed.gov/21272743 21272743]</ref><ref name="pmid18178401">Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18178401 Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients.] ''Am J Cardiol'' 101 (2):169-72. [http://dx.doi.org/10.1016/j.amjcard.2007.08.054DOI:10.1016/j.amjcard.2007.08.054] PMID: [http://pubmed.gov/18178401 18178401]</ref><ref name="pmid18237682">Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18237682 Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization.] ''J Am Coll Cardiol'' 51 (5):538-45.[http://dx.doi.org/10.1016/j.jacc.2007.09.054 DOI:10.1016/j.jacc.2007.09.054] PMID:[http://pubmed.gov/18237682 18237682]</ref><ref name="pmid16717151">Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M et al. (2006)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16717151 Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.]''Circulation'' 113 (21):2542-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595694DOI:10.1161/CIRCULATIONAHA.105.595694] PMID: [http://pubmed.gov/16717151 16717151]</ref><ref name="pmid16487857">Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. (2006)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16487857 Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.] ''J Am Coll Cardiol'' 47 (4):864-70. [http://dx.doi.org/10.1016/j.jacc.2005.09.072DOI:10.1016/j.jacc.2005.09.072] PMID: [http://pubmed.gov/16487857 16487857]</ref><ref name="pmid18608116">Mäkikallio TH, Niemelä M, Kervinen K, Jokinen V, Laukkanen J, Ylitalo I et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18608116 Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting.] ''Ann Med'' 40 (6):437-43. [http://dx.doi.org/10.1080/07853890701879790 DOI:10.1080/07853890701879790]PMID: [http://pubmed.gov/18608116 18608116]</ref><ref name="pmid19695542">Naik H, White AJ, Chakravarty T, Forrester J, Fontana G, Kar S et al. (2009)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19695542 A meta-analysis of 3,773 patients treated with percutaneous coronary intervention or surgery for unprotected left main coronary artery stenosis.]''JACC Cardiovasc Interv'' 2 (8):739-47. [http://dx.doi.org/10.1016/j.jcin.2009.05.020DOI:10.1016/j.jcin.2009.05.020] PMID: [http://pubmed.gov/19695542 19695542]</ref><ref name="pmid16784920">Palmerini T, Marzocchi A, Marrozzini C, Ortolani P, Saia F, Savini C et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16784920 Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry).] ''Am J Cardiol'' 98 (1):54-9.[http://dx.doi.org/10.1016/j.amjcard.2006.01.070 DOI:10.1016/j.amjcard.2006.01.070] PMID:[http://pubmed.gov/16784920 16784920]</ref><ref name="pmid20451344">Park DW, Seung KB, Kim YH, Lee JY, Kim WJ, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20451344 Long-term safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 5-year results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry.] ''J Am Coll Cardiol'' 56 (2):117-24. [http://dx.doi.org/10.1016/j.jacc.2010.04.004DOI:10.1016/j.jacc.2010.04.004] PMID: [http://pubmed.gov/20451344 20451344]</ref><ref name="pmid19029471">Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19029471 Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.] ''Circulation'' 118 (23):2374-81.[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.727099 DOI:10.1161/CIRCULATIONAHA.107.727099] PMID:[http://pubmed.gov/19029471 19029471]</ref><ref name="pmid17826380">Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17826380 Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease.] ''Am J Cardiol'' 100 (6):970-3.[http://dx.doi.org/10.1016/j.amjcard.2007.04.037 DOI:10.1016/j.amjcard.2007.04.037] PMID:[http://pubmed.gov/17826380 17826380]</ref><ref name="pmid18378517">Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18378517 Stents versus coronary-artery bypass grafting for left main coronary artery disease.] ''N Engl J Med'' 358 (17):1781-92.[http://dx.doi.org/10.1056/NEJMoa0801441 DOI:10.1056/NEJMoa0801441] PMID:[http://pubmed.gov/18378517 18378517]</ref><ref name="pmid19463306">White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19463306 Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis.]''JACC Cardiovasc Interv'' 1 (3):236-45. [http://dx.doi.org/10.1016/j.jcin.2008.02.007DOI:10.1016/j.jcin.2008.02.007] PMID: [http://pubmed.gov/19463306 19463306]</ref><ref name="pmid21463149">Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG et al. (2011)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21463149 Randomized trial of stents versus bypass surgery for left main coronary artery disease.] ''N Engl J Med'' 364 (18):1718-27.[http://dx.doi.org/10.1056/NEJMoa1100452 DOI:10.1056/NEJMoa1100452] PMID:[http://pubmed.gov/2146314921463149]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
===ACCF/AHA Guidelines for Revascularization to Improve Survival: Non-Left Main Coronary Artery Disease<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''1.''' [[CABG]] or PCI to improve survival is beneficial in survivors of [[sudden cardiac death]]with presumed [[ischemia]]-mediated [[ventricular tachycardia]] caused by significant (greater than or equal to 70% diameter) [[stenosis]] in a major coronary artery. ([[CABG]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <ref name="pmid12667561">{{cite journal |author=Borger van der Burg AE, Bax JJ, Boersma E, Bootsma M, van Erven L, van der Wall EE, Schalij MJ |title=Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital |journal=[[The American Journal of Cardiology]] |volume=91 |issue=7 |pages=785–9 |year=2003 |month=April |pmid=12667561 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0002914903000080|accessdate=2011-12-04}}</ref><ref name="pmid1593036">{{cite journal |author=Every NR, Fahrenbruch CE, Hallstrom AP, Weaver WD, Cobb LA |title=Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest |journal=[[Journal of the American College of Cardiology]] |volume=19 |issue=7 |pages=1435–9 |year=1992 |month=June|pmid=1593036 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0735-1097(92)90599-I|accessdate=2011-12-04}}</ref><ref name="pmid1081278">{{cite journal |author=Kaiser GA, Ghahramani A, Bolooki H, Vargas A, Thurer RJ, Williams WH, Myerburg RJ |title=Role of coronary artery surgery in patients surviving unexpected cardiac arrest |journal=[[Surgery]] |volume=78 |issue=6|pages=749–54 |year=1975 |month=December |pmid=1081278 |doi= |url= |accessdate=2011-12-04}}</ref>; PCI ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <ref name="pmid12667561">{{cite journal |author=Borger van der Burg AE, Bax JJ, Boersma E, Bootsma M, van Erven L, van der Wall EE, Schalij MJ |title=Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital |journal=[[The American Journal of Cardiology]] |volume=91 |issue=7 |pages=785–9 |year=2003 |month=April|pmid=12667561 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914903000080|accessdate=2011-12-04}}</ref>)<nowiki>"</nowiki>
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{|class="wikitable"
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|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
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|bgcolor="LightCoral"|
<nowiki>"</nowiki>'''1.''' [[CABG]] or PCI should not be performed with the primary or sole intent to improve survival in patients with [[chronic stable angina definition|stable ischemic heart disease]] with 1 or more[[stenosis|coronary stenoses]] that are not anatomically or functionally significant (e.g., greater than 70% diameter non–left main coronary artery stenosis, [[Fractional flow reserve|fractional flow reserve]] 0.80, no or only mild [[ischemia]] on noninvasive testing), involve only the [[Left circumflex artery|left circumflex]] or [[right coronary artery]], or subtend only a small area of viable myocardium. <ref name="pmid7914958">{{cite journal |author=Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R |title=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 |journal=[[Lancet]] |volume=344|issue=8922 |pages=563–70 |year=1994 |month=August |pmid=7914958 |doi= |url=|accessdate=2011-12-04}}</ref><ref name="pmid8622299">{{cite journal |author=Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM|title=Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=111 |issue=5 |pages=1013–25 |year=1996 |month=May |pmid=8622299|doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(96)70378-1|accessdate=2011-12-04}}</ref><ref name="pmid9832692">{{cite journal |author=Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, Fromm B |title=Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=116 |issue=6 |pages=997–1004 |year=1998 |month=December|pmid=9832692 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522398004759|accessdate=2011-12-04}}</ref><ref name="pmid12771008">{{cite journal |author=Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS |title=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|journal=[[Circulation]] |volume=107 |issue=23 |pages=2900–7 |year=2003 |month=June |pmid=12771008|doi=10.1161/01.CIR.0000072790.23090.41 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12771008 |accessdate=2011-12-04}}</ref><ref name="pmid18268144">{{cite journal|author=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|title=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 |journal=[[Circulation]] |volume=117 |issue=10|pages=1283–91 |year=2008 |month=March |pmid=18268144 |doi=10.1161/CIRCULATIONAHA.107.743963|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18268144|accessdate=2011-12-04}}</ref><ref name="pmid6332274">{{cite journal |author=Cashin WL, Sanmarco ME, Nessim SA, Blankenhorn DH |title=Accelerated progression of atherosclerosis in coronary vessels with minimal lesions that are bypassed |journal=[[The New England Journal of Medicine]] |volume=311|issue=13 |pages=824–8 |year=1984 |month=September |pmid=6332274 |doi=10.1056/NEJM198409273111304|url=http://www.nejm.org/doi/abs/10.1056/NEJM198409273111304?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed|accessdate=2011-12-04}}</ref><ref name="pmid8637515">{{cite journal |author=Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, Koolen JJ |title=Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses |journal=[[The New England Journal of Medicine]] |volume=334 |issue=26 |pages=1703–8 |year=1996 |month=June|pmid=8637515 |doi=10.1056/NEJM199606273342604 |url=http://dx.doi.org/10.1056/NEJM199606273342604|accessdate=2011-12-04}}</ref><ref name="pmid19144937">{{cite journal |author=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 |title=Fractional flow reserve versus angiography for guiding percutaneous coronary intervention |journal=[[The New England Journal of Medicine]] |volume=360|issue=3 |pages=213–24 |year=2009 |month=January |pmid=19144937 |doi=10.1056/NEJMoa0807611|url=http://dx.doi.org/10.1056/NEJMoa0807611 |accessdate=2011-12-04}}</ref><ref name="pmid14680734">{{cite journal |author=Sawada S, Bapat A, Vaz D, Weksler J, Fineberg N, Greene A, Gradus-Pizlo I, Feigenbaum H |title=Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction|journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=12 |pages=2099–105|year=2003 |month=December |pmid=14680734 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703012737 |accessdate=2011-12-04}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' It is reasonable to choose [[CABG]] over PCI to improve survival in patients with complex[[CAD|3-vessel CAD]] (e.g., [[SYNTAX|SYNTAX score]] greater than 22) with or without involvement of the [[LAD|proximal LAD]] artery who are good candidates for [[CABG]]. <ref name="pmid16996946">{{cite journal |author=Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH |title=Selection of surgical or percutaneous coronary intervention provides differential longevity benefit|journal=[[The Annals of Thoracic Surgery]]|volume=82 |issue=4 |pages=1420–8; discussion 1428–9 |year=2006 |month=October|pmid=16996946|doi=10.1016/j.athoracsur.2006.04.044|url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00829-0|accessdate=2011-12-04}}</ref><ref name="pmid15117846">{{cite journal |author=Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS|title=Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features |journal=[[Circulation]] |volume=109 |issue=19 |pages=2290–5 |year=2004|month=May |pmid=15117846|doi=10.1161/01.CIR.0000126826.58526.14|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15117846|accessdate=2011-12-04}}</ref><ref name="pmid18216353">{{cite journal |author=Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH |title=Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease |journal=[[The New England Journal of Medicine]] |volume=358 |issue=4 |pages=331–41 |year=2008 |month=January|pmid=18216353 |doi=10.1056/NEJMoa071804 |url=http://dx.doi.org/10.1056/NEJMoa071804|accessdate=2011-12-04}}</ref><ref name="pmid21697170">{{cite journal |author=Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A|title=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 |journal=[[European Heart Journal]] |volume=32 |issue=17 |pages=2125–34 |year=2011 |month=September |pmid=21697170|doi=10.1093/eurheartj/ehr213 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21697170 |accessdate=2011-12-04}}</ref><ref name="pmid15917382">{{cite journal|author=Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA |title=Long-term outcomes of coronary-artery bypass grafting versus stent implantation|journal=[[The New England Journal of Medicine]] |volume=352 |issue=21 |pages=2174–83 |year=2005|month=May |pmid=15917382 |doi=10.1056/NEJMoa040316 |url=http://dx.doi.org/10.1056/NEJMoa040316|accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''2.''' [[CABG]] is probably recommended in preference to PCI to improve survival in patients with[[CAD|multivessel CAD]] and [[diabetes mellitus]], particularly if a [[LIMA|left internal mammary artery graft]] can be anastomosed to the [[LAD|LAD artery]]. <ref name="pmid16159837">{{cite journal|author=Sorajja P, Chareonthaitawee P, Rajagopalan N, Miller TD, Frye RL, Hodge DO, Gibbons RJ|title=Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting |journal=[[Circulation]] |volume=112 |issue=9 Suppl |pages=I311–6|year=2005 |month=August |pmid=16159837 |doi=10.1161/CIRCULATIONAHA.104.525022|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16159837|accessdate=2011-12-04}}</ref><ref name="pmid9323059">{{cite journal |author= |title=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)|journal=[[Circulation]] |volume=96 |issue=6 |pages=1761–9 |year=1997 |month=September |pmid=9323059|doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9323059|accessdate=2011-12-04}}</ref><ref name="pmid17433949">{{cite journal |author= |title=The final 10-year follow-up results from the BARI randomized trial |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=15 |pages=1600–6 |year=2007 |month=April |pmid=17433949|doi=10.1016/j.jacc.2006.11.048|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00432-9|accessdate=2011-12-04}}</ref><ref name="pmid20079596">{{cite journal |author=Banning AP, Westaby S, Morice MC, Kappetein AP, Mohr FW, Berti S, Glauber M, Kellett MA, Kramer RS, Leadley K, Dawkins KD, Serruys PW |title=Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents|journal=[[Journal of the American College of Cardiology]] |volume=55 |issue=11 |pages=1067–75|year=2010 |month=March |pmid=20079596 |doi=10.1016/j.jacc.2009.09.057|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)04074-1|accessdate=2011-12-04}}</ref><ref name="pmid15917382">{{cite journal |author=Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA |title=Long-term outcomes of coronary-artery bypass grafting versus stent implantation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=21 |pages=2174–83 |year=2005 |month=May |pmid=15917382|doi=10.1056/NEJMoa040316 |url=http://dx.doi.org/10.1056/NEJMoa040316|accessdate=2011-12-04}}</ref><ref name="pmid17339566">{{cite journal |author=Hueb W, Lopes NH, Gersh BJ, Soares P, Machado LA, Jatene FB, Oliveira SA, Ramires JA |title=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 |journal=[[Circulation]] |volume=115|issue=9 |pages=1082–9 |year=2007 |month=March |pmid=17339566 |doi=10.1161/CIRCULATIONAHA.106.625475|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17339566|accessdate=2011-12-04}}</ref><ref name="pmid16159849">{{cite journal |author=Malenka DJ, Leavitt BJ, Hearne MJ, Robb JF, Baribeau YR, Ryan TJ, Helm RE, Kellett MA, Dauerman HL, Dacey LJ, Silver MT, VerLee PN, Weldner PW, Hettleman BD, Olmstead EM, Piper WD, O'Connor GT |title=Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England |journal=[[Circulation]] |volume=112 |issue=9 Suppl |pages=I371–6|year=2005 |month=August |pmid=16159849 |doi=10.1161/CIRCULATIONAHA.104.526392|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16159849|accessdate=2011-12-04}}</ref><ref name="pmid11263600">{{cite journal |author=Niles NW, McGrath PD, Malenka D, Quinton H, Wennberg D, Shubrooks SJ, Tryzelaar JF, Clough R, Hearne MJ, Hernandez F, Watkins MW, O'Connor GT |title=Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. Northern New England Cardiovascular Disease Study Group |journal=[[Journal of the American College of Cardiology]] |volume=37 |issue=4 |pages=1008–15 |year=2001 |month=March|pmid=11263600 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109700012055|accessdate=2011-12-04}}</ref><ref name="pmid9426011">{{cite journal |author=Weintraub WS, Stein B, Kosinski A, Douglas JS, Ghazzal ZM, Jones EL, Morris DC, Guyton RA, Craver JM, King SB|title=Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease |journal=[[Journal of the American College of Cardiology]]|volume=31 |issue=1 |pages=10–9 |year=1998 |month=January |pmid=9426011 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(97)00441-5|accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIb]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' The usefulness of PCI to improve survival is uncertain in patients with [[CAD|2- or 3-vessel CAD]] (with or without involvement of the [[LAD|proximal LAD artery]]) or [[LAD|1-vessel proximal LAD]] [[CAD|disease]]. <ref name="pmid11431667">{{cite journal |author=Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD, Galbraith PD, Hui W, Faris P, Knudtson ML|title=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 |journal=[[American Heart Journal]] |volume=142 |issue=1|pages=119–26 |year=2001 |month=July |pmid=11431667 |doi=10.1067/mhj.2001.116072|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(01)66057-5|accessdate=2011-12-04}}</ref><ref name="pmid8622299">{{cite journal |author=Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM|title=Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=111 |issue=5 |pages=1013–25 |year=1996 |month=May |pmid=8622299|doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(96)70378-1|accessdate=2011-12-04}}</ref><ref name="pmid16996946">{{cite journal |author=Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH |title=Selection of surgical or percutaneous coronary intervention provides differential longevity benefit|journal=[[The Annals of Thoracic Surgery]] |volume=82 |issue=4 |pages=1420–8; discussion 1428–9|year=2006 |month=October |pmid=16996946 |doi=10.1016/j.athoracsur.2006.04.044|url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00829-0|accessdate=2011-12-04}}</ref><ref name="pmid17387127">{{cite journal |author=Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS |title=Optimal medical therapy with or without PCI for stable coronary disease |journal=[[The New England Journal of Medicine]] |volume=356 |issue=15 |pages=1503–16|year=2007 |month=April |pmid=17387127 |doi=10.1056/NEJMoa070829|url=http://dx.doi.org/10.1056/NEJMoa070829 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''2.''' The usefulness of [[CABG]] or PCI to improve survival is uncertain in patients with previous [[CABG]] and extensive anterior wall [[ischemia]] on noninvasive testing. <ref name="pmid16272211">{{cite journal |author=Brener SJ, Lytle BW, Casserly IP, Ellis SG, Topol EJ, Lauer MS |title=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 |journal=[[European Heart Journal]] |volume=27 |issue=4|pages=413–8 |year=2006 |month=February |pmid=16272211 |doi=10.1093/eurheartj/ehi646|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16272211|accessdate=2011-12-04}}</ref><ref name="pmid17045681">{{cite journal |author=Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA |title=Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery |journal=[[International Journal of Cardiology]] |volume=119 |issue=1 |pages=65–72 |year=2007 |month=June |pmid=17045681|doi=10.1016/j.ijcard.2006.07.058|url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00905-3|accessdate=2011-12-04}}</ref><ref name="pmid8468995">{{cite journal |author=Lytle BW, Loop FD, Taylor PC, Goormastic M, Stewart RW, Novoa R, McCarthy P, Cosgrove DM |title=The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=105 |issue=4|pages=605–12; discussion 612–4 |year=1993 |month=April |pmid=8468995 |doi= |url=|accessdate=2011-12-04}}</ref><ref name="pmid11451264">{{cite journal |author=Morrison DA, Sethi G, Sacks J, Henderson W, Grover F, Sedlis S, Esposito R, Ramanathan K, Weiman D, Saucedo J, Antakli T, Paramesh V, Pett S, Vernon S, Birjiniuk V, Welt F, Krucoff M, Wolfe W, Lucke JC, Mediratta S, Booth D, Barbiere C, Lewis D |title=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) |journal=[[Journal of the American College of Cardiology]] |volume=38 |issue=1|pages=143–9 |year=2001 |month=July |pmid=11451264 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109701013663|accessdate=2011-12-04}}</ref><ref name="pmid10467648">{{cite journal |author=Pfautsch P, Frantz E, Ellmer A, Sauer HU, Fleck E |title=[Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization] |language=German |journal=[[Zeitschrift Für Kardiologie]]|volume=88 |issue=7 |pages=489–97 |year=1999 |month=July |pmid=10467648 |doi=|url=http://link.springer.de/link/service/journals/00392/bibs/9088007/90880489.htm|accessdate=2011-12-04}}</ref><ref name="pmid9860204">{{cite journal |author=Sergeant P, Blackstone E, Meyns B, Stockman B, Jashari R |title=First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting |journal=[[European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery]]|volume=14 |issue=5 |pages=480–7 |year=1998 |month=November |pmid=9860204 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S1010794098002140|accessdate=2011-12-04}}</ref><ref name="pmid8890807">{{cite journal |author=Stephan WJ, O'Keefe JH, Piehler JM, McCallister BD, Dahiya RS, Shimshak TM, Ligon RW, Hartzler GO |title=Coronary angioplasty versus repeat coronary artery bypass grafting for patients with previous bypass surgery|journal=[[Journal of the American College of Cardiology]] |volume=28 |issue=5 |pages=1140–6|year=1996 |month=November |pmid=8890807 |doi=10.1016/S0735-1097(96)00286-0|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(96)00286-0|accessdate=2011-12-04}}</ref><ref name="pmid19379872">{{cite journal |author=Subramanian S, Sabik JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW |title=Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending |journal=[[The Annals of Thoracic Surgery]] |volume=87 |issue=5 |pages=1392–8; discussion 1400 |year=2009 |month=May|pmid=19379872 |doi=10.1016/j.athoracsur.2009.02.032|url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)00309-9|accessdate=2011-12-04}}</ref><ref name="pmid9054744">{{cite journal |author=Weintraub WS, Jones EL, Morris DC, King SB, Guyton RA, Craver JM |title=Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery |journal=[[Circulation]] |volume=95|issue=4 |pages=868–77 |year=1997 |month=February |pmid=9054744 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9054744|accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
===ACCF/AHA Guidelines for Revascularization to Improve Symptoms<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</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.''' [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] or[[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms is beneficial in patients with 1 or more significant (greater than 70% diameter) coronary artery [[stenoses]] amenable to [[Chronic stable angina revascularization|revascularization]] and unacceptable [[chronic stable angina|angina]] despite [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]]. <ref name="pmid17387127">{{cite journal |author=Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS|title=Optimal medical therapy with or without PCI for stable coronary disease |journal=[[The New England Journal of Medicine]] |volume=356 |issue=15 |pages=1503–16 |year=2007 |month=April|pmid=17387127 |doi=10.1056/NEJMoa070829 |url=http://dx.doi.org/10.1056/NEJMoa070829|accessdate=2011-12-06}}</ref><ref name="pmid11583747">{{cite journal |author= |title=Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial |journal=[[Lancet]] |volume=358 |issue=9286 |pages=951–7 |year=2001|month=September |pmid=11583747 |doi=10.1016/S0140-6736(01)06100-1|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(01)06100-1|accessdate=2011-12-06}}</ref><ref name="pmid12928741">{{cite journal |author=Benzer W, Höfer S, Oldridge NB |title=Health-related quality of life in patients with coronary artery disease after different treatments for angina in routine clinical practice |journal=[[Herz]] |volume=28 |issue=5|pages=421–8 |year=2003 |month=August |pmid=12928741 |doi=10.1007/s00059-003-2388-9|url=http://dx.doi.org/10.1007/s00059-003-2388-9 |accessdate=2011-12-06}}</ref><ref name="pmid16174598">{{cite journal |author=Bonaros N, Schachner T, Ohlinger A, Friedrich G, Laufer G, Bonatti J |title=Assessment of health-related quality of life after coronary revascularization|journal=[[The Heart Surgery Forum]] |volume=8 |issue=5 |pages=E380–5 |year=2005 |pmid=16174598|doi=10.1532/HSF98.20051139 |url=http://cardenjennings.metapress.com/openurl.asp?genre=article&id=doi:10.1532/HSF98.20051139 |accessdate=2011-12-06}}</ref><ref name="pmid10884254">{{cite journal |author=Bucher HC, Hengstler P, Schindler C, Guyatt GH|title=Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials |journal=[[BMJ (Clinical Research Ed.)]] |volume=321 |issue=7253 |pages=73–7 |year=2000 |month=July |pmid=10884254 |pmc=27425|doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=10884254 |accessdate=2011-12-06}}</ref><ref name="pmid16876891">{{cite journal |author=Favarato ME, Hueb W, Boden WE, Lopes N, Nogueira CR, Takiuti M, Góis AF, Borges JC, Favarato D, Aldrighi JM, Oliveira SA, Ramires JA |title=Quality of life in patients with symptomatic multivessel coronary artery disease: a comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS II trial |journal=[[International Journal of Cardiology]] |volume=116 |issue=3 |pages=364–70 |year=2007 |month=April |pmid=16876891|doi=10.1016/j.ijcard.2006.06.001|url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00478-5|accessdate=2011-12-06}}</ref><ref name="pmid20733102">{{cite journal |author=Hueb W, Lopes N, Gersh BJ, Soares PR, Ribeiro EE, Pereira AC, Favarato D, Rocha AS, Hueb AC, Ramires JA |title=Ten-year follow-up survival of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease|journal=[[Circulation]] |volume=122 |issue=10 |pages=949–57 |year=2010 |month=September|pmid=20733102 |doi=10.1161/CIRCULATIONAHA.109.911669|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=20733102|accessdate=2011-12-06}}</ref><ref name="pmid8674171">{{cite journal |author=Pocock SJ, Henderson RA, Seed P, Treasure T, Hampton JR |title=Quality of life, employment status, and anginal symptoms after coronary angioplasty or bypass surgery. 3-year follow-up in the Randomized Intervention Treatment of Angina (RITA) Trial |journal=[[Circulation]] |volume=94 |issue=2 |pages=135–42|year=1996 |month=July |pmid=8674171 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=8674171 |accessdate=2011-12-06}}</ref><ref name="pmid10732887">{{cite journal|author=Pocock SJ, Henderson RA, Clayton T, Lyman GH, Chamberlain DA |title=Quality of life after coronary angioplasty or continued medical treatment for angina: three-year follow-up in the RITA-2 trial. Randomized Intervention Treatment of Angina |journal=[[Journal of the American College of Cardiology]] |volume=35 |issue=4 |pages=907–14 |year=2000 |month=March |pmid=10732887 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109799006373|accessdate=2011-12-06}}</ref><ref name="pmid18703470">{{cite journal |author=Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, Zhang W, Hartigan PM, Lewis C, Veledar E, Bowen J, Dunbar SB, Deaton C, Kaufman S, O'Rourke RA, Goeree R, Barnett PG, Teo KK, Boden WE, Mancini GB|title=Effect of PCI on quality of life in patients with stable coronary disease |journal=[[The New England Journal of Medicine]] |volume=359 |issue=7 |pages=677–87 |year=2008 |month=August|pmid=18703470 |doi=10.1056/NEJMoa072771 |url=http://dx.doi.org/10.1056/NEJMoa072771|accessdate=2011-12-06}}</ref><ref name="pmid20231568">{{cite journal |author=Wijeysundera HC, Nallamothu BK, Krumholz HM, Tu JV, Ko DT |title=Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief |journal=[[Annals of Internal Medicine]]|volume=152 |issue=6 |pages=370–9 |year=2010 |month=March |pmid=20231568|doi=10.1059/0003-4819-152-6-201003160-00007 |url= |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|bgcolor="LightCoral"|
<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] or[[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms should not be performed in patients who do not meet anatomic (greater than 50% left main or greater than 70% non–left main stenosis) or physiological (e.g., abnormal [[fractional flow reserve]]) criteria for [[Chronic stable angina revascularization|revascularization]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] or[[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms is reasonable in patients with 1 or more significant (greater than 70% diameter) coronary artery stenoses and unacceptable [[chronic stable angina|angina]] for whom [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]] cannot be implemented because of medication contraindications, adverse effects, or patient preferences. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms is reasonable in patients with previous [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]], 1 or more significant (greater than 70% diameter) coronary artery stenoses associated with [[ischemia]], and unacceptable [[chronic stable angina|angina]]despite [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]]. <ref name="pmid17045681">{{cite journal|author=Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA|title=Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery|journal=[[International Journal of Cardiology]] |volume=119 |issue=1 |pages=65–72 |year=2007|month=June |pmid=17045681 |doi=10.1016/j.ijcard.2006.07.058|url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00905-3|accessdate=2011-12-06}}</ref><ref name="pmid10467648">{{cite journal |author=Pfautsch P, Frantz E, Ellmer A, Sauer HU, Fleck E |title=[Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization] |language=German |journal=[[Zeitschrift Für Kardiologie]]|volume=88 |issue=7 |pages=489–97 |year=1999 |month=July |pmid=10467648 |doi=|url=http://link.springer.de/link/service/journals/00392/bibs/9088007/90880489.htm|accessdate=2011-12-06}}</ref><ref name="pmid19379872">{{cite journal |author=Subramanian S, Sabik JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW |title=Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending |journal=[[The Annals of Thoracic Surgery]] |volume=87 |issue=5 |pages=1392–8; discussion 1400 |year=2009 |month=May|pmid=19379872 |doi=10.1016/j.athoracsur.2009.02.032|url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)00309-9|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''3.''' It is reasonable to choose [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] over [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms in patients with complex 3-vessel [[CAD]] (e.g.,[[SYNTAX|SYNTAX score]] greater than 22), with or without involvement of the [[LAD|proximal LAD artery]] who are good candidates for [[CABG]]. <ref name="pmid18216353">{{cite journal|author=Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH |title=Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease|journal=[[The New England Journal of Medicine]] |volume=358 |issue=4 |pages=331–41 |year=2008|month=January |pmid=18216353 |doi=10.1056/NEJMoa071804 |url=http://dx.doi.org/10.1056/NEJMoa071804|accessdate=2011-12-06}}</ref><ref name="pmid21697170">{{cite journal |author=Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A|title=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 |journal=[[European Heart Journal]] |volume=32 |issue=17 |pages=2125–34 |year=2011 |month=September |pmid=21697170|doi=10.1093/eurheartj/ehr213 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21697170 |accessdate=2011-12-06}}</ref><ref name="pmid15117846">{{cite journal|author=Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS |title=Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features |journal=[[Circulation]] |volume=109|issue=19 |pages=2290–5 |year=2004 |month=May |pmid=15117846 |doi=10.1161/01.CIR.0000126826.58526.14|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15117846|accessdate=2011-12-06}}</ref><ref name="pmid15917382">{{cite journal |author=Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA |title=Long-term outcomes of coronary-artery bypass grafting versus stent implantation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=21 |pages=2174–83 |year=2005 |month=May |pmid=15917382|doi=10.1056/NEJMoa040316 |url=http://dx.doi.org/10.1056/NEJMoa040316 |accessdate=2011-12-06}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIb]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] to improve symptoms might be reasonable for patients with previous [[CABG]], 1 or more significant (greater than 70% diameter) coronary artery stenoses not amenable to [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]], and unacceptable [[chronic stable angina|angina]] despite [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]]. <ref name="pmid9054744">{{cite journal|author=Weintraub WS, Jones EL, Morris DC, King SB, Guyton RA, Craver JM |title=Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery|journal=[[Circulation]] |volume=95 |issue=4 |pages=868–77 |year=1997 |month=February |pmid=9054744|doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9054744|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
==Procedure==
The term [[balloon angioplasty]] is commonly used to describe percutaneous coronary intervention, which describes the inflation of a balloon within the coronary artery to crush the plaque into the walls of the artery.  While balloon angioplasty is still done as a part of nearly all percutaneous coronary interventions, it is rarely the only procedure performed.
 
Other procedures that are done during a percutaneous coronary intervention include:
* Implantation of [[stent]]s
* Rotational or laser [[atherectomy]]
* [[Brachytherapy]]
 
Balloon angioplasty is now used to facilitate stent deployment.
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Procedural Considerations <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===ACCF/AHA Guidelines for PCI in patients with Stable Ischemic Heart Disease (SIHD)<ref name="pmid19942100">{{cite journal |author=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 |title=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=[[Journal of the American College of Cardiology]] |volume=54 |issue=23|pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9|accessdate=2011-12-06}}</ref>===
 
===PCI in patients with ST-Elevation Myocardial Infarction<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
=====Coronary Angiography Strategies in STEMI<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</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.''' A strategy of immediate [[ST elevation myocardial infarction coronary angiography|coronary angiography]] with intent to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] (or [[ST elevation myocardial infarction coronary artery bypass grafting|emergency CABG]]) in patients with [[STEMI]] is recommended for:
 
:'''a.''' Patients who are candidates for [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]].<ref name="pmid11960536">{{cite journal|author=Aversano T, Aversano LT, Passamani E, Knatterud GL, Terrin ML, Williams DO, Forman SA|title=Thrombolytic therapy vs primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery: a randomized controlled trial|journal=[[JAMA : the Journal of the American Medical Association]] |volume=287 |issue=15|pages=1943–51 |year=2002 |month=April |pmid=11960536 |doi=|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11960536|accessdate=2011-12-07}}</ref><ref name="pmid12517460">{{cite journal |author=Keeley EC, Boura JA, Grines CL |title=Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials |journal=[[Lancet]] |volume=361|issue=9351 |pages=13–20 |year=2003 |month=January |pmid=12517460 |doi=10.1016/S0140-6736(03)12113-7|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)12113-7|accessdate=2011-12-07}}</ref><ref name="pmid8433726">{{cite journal |author=Zijlstra F, de Boer MJ, Hoorntje JC, Reiffers S, Reiber JH, Suryapranata H |title=A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=328 |issue=10 |pages=680–4 |year=1993 |month=March |pmid=8433726|doi=10.1056/NEJM199303113281002 |url=http://dx.doi.org/10.1056/NEJM199303113281002|accessdate=2011-12-07}}</ref><ref name="pmid14871919">{{cite journal |author=Keeley EC, Grines CL|title=Primary coronary intervention for acute myocardial infarction |journal=[[JAMA : the Journal of the American Medical Association]] |volume=291 |issue=6 |pages=736–9 |year=2004 |month=February|pmid=14871919 |doi=10.1001/jama.291.6.736 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=14871919 |accessdate=2011-12-07}}</ref><ref name="pmid17202455">{{cite journal|author=Keeley EC, Hillis LD |title=Primary PCI for myocardial infarction with ST-segment elevation|journal=[[The New England Journal of Medicine]] |volume=356 |issue=1 |pages=47–54 |year=2007|month=January |pmid=17202455 |doi=10.1056/NEJMct063503 |url=http://dx.doi.org/10.1056/NEJMct063503|accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
:'''b.''' Patients with [[heart failure|severe heart failure]] or [[cardiogenic shock]] who are suitable candidates for revascularization.<ref name="pmid12392826">{{cite journal |author=Wu AH, Parsons L, Every NR, Bates ER |title=Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2) |journal=[[Journal of the American College of Cardiology]] |volume=40|issue=8 |pages=1389–94 |year=2002 |month=October |pmid=12392826 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702021733|accessdate=2011-12-07}}</ref><ref name="pmid10460813">{{cite journal |author=Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH |title=Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock |journal=[[The New England Journal of Medicine]] |volume=341 |issue=9 |pages=625–34 |year=1999|month=August |pmid=10460813 |doi=10.1056/NEJM199908263410901|url=http://dx.doi.org/10.1056/NEJM199908263410901 |accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' A strategy of immediate [[ST elevation myocardial infarction coronary angiography|coronary angiography]] (or transfer for immediate coronary angiography) with intent to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable for patients with [[STEMI]], a moderate to large area of myocardium at risk, and evidence of failed [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]].<ref name="pmid16382062">{{cite journal |author=Gershlick AH, Stephens-Lloyd A, Hughes S, Abrams KR, Stevens SE, Uren NG, de Belder A, Davis J, Pitt M, Banning A, Baumbach A, Shiu MF, Schofield P, Dawkins KD, Henderson RA, Oldroyd KG, Wilcox R |title=Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=353 |issue=26 |pages=2758–68|year=2005 |month=December |pmid=16382062 |doi=10.1056/NEJMoa050849|url=http://dx.doi.org/10.1056/NEJMoa050849 |accessdate=2011-12-07}}</ref><ref name="pmid17258087">{{cite journal |author=Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO, Kashani A, You JJ, Tu JV, Ko DT |title=Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=4|pages=422–30 |year=2007 |month=January |pmid=17258087 |doi=10.1016/j.jacc.2006.09.033|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)02661-1|accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''2.''' A strategy of [[ST elevation myocardial infarction coronary angiography|coronary angiography]] (or transfer for coronary angiography) 3 to 24 hours after initiating [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]] with intent to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable for hemodynamically stable patients with [[STEMI]] and evidence for successful [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]] when angiography and revascularization can be performed as soon as logistically feasible in this time frame.<ref name="pmid19747792">{{cite journal |author=Bøhmer E, Hoffmann P, Abdelnoor M, Arnesen H, Halvorsen S |title=Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction) |journal=[[Journal of the American College of Cardiology]] |volume=55 |issue=2 |pages=102–10 |year=2010 |month=January |pmid=19747792|doi=10.1016/j.jacc.2009.08.007|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02642-4|accessdate=2011-12-07}}</ref><ref name="pmid18280326">{{cite journal |author=Di Mario C, Dudek D, Piscione F, Mielecki W, Savonitto S, Murena E, Dimopoulos K, Manari A, Gaspardone A, Ochala A, Zmudka K, Bolognese L, Steg PG, Flather M |title=Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial|journal=[[Lancet]] |volume=371 |issue=9612 |pages=559–68 |year=2008 |month=February |pmid=18280326|doi=10.1016/S0140-6736(08)60268-8|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60268-8|accessdate=2011-12-07}}</ref><ref name="pmid15380963">{{cite journal |author=Fernandez-Avilés F, Alonso JJ, Castro-Beiras A, Vázquez N, Blanco J, Alonso-Briales J, López-Mesa J, Fernández-Vazquez F, Calvo I, Martínez-Elbal L, San Román JA, Ramos B |title=Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial |journal=[[Lancet]] |volume=364|issue=9439 |pages=1045–53 |year=2004 |pmid=15380963 |doi=10.1016/S0140-6736(04)17059-1|url=http://linkinghub.elsevier.com/retrieve/pii/S0140673604170591|accessdate=2011-12-07}}</ref><ref name="pmid20601393">{{cite journal |author=Borgia F, Goodman SG, Halvorsen S, Cantor WJ, Piscione F, Le May MR, Fernández-Avilés F, Sánchez PL, Dimopoulos K, Scheller B, Armstrong PW, Di Mario C |title=Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis|journal=[[European Heart Journal]] |volume=31 |issue=17 |pages=2156–69 |year=2010 |month=September|pmid=20601393 |doi=10.1093/eurheartj/ehq204|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20601393|accessdate=2011-12-07}}</ref><ref name="pmid19553646">{{cite journal |author=Cantor WJ, Fitchett D, Borgundvaag B, Ducas J, Heffernan M, Cohen EA, Morrison LJ, Langer A, Dzavik V, Mehta SR, Lazzam C, Schwartz B, Casanova A, Goodman SG |title=Routine early angioplasty after fibrinolysis for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=360 |issue=26|pages=2705–18 |year=2009 |month=June |pmid=19553646 |doi=10.1056/NEJMoa0808276|url=http://dx.doi.org/10.1056/NEJMoa0808276 |accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
 
=====Patients With STEMI: General and Specific Considerations<ref name="pmid19942100">{{cite journal |author=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 |title=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=[[Journal of the American College of Cardiology]] |volume=54 |issue=23|pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9|accessdate=2011-12-06}}</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.''' If immediately available, [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] should be performed in patients with [[STEMI]](including true posterior MI) or MI with new or presumably new [[Left bundle branch block|left bundle-branch block]] who can undergo PCI of the infarct artery within 12 hours of symptom onset, if performed in a timely fashion (balloon inflation goal within 90 minutes of presentation) by persons skilled in the procedure (individuals who perform more than 75 PCI procedures per year, ideally at least 11 PCIs per year for [[STEMI]]). The procedure should be supported by experienced personnel in an appropriate laboratory environment (one that performs more than 200 PCI procedures per year, of which at least 36 are primary PCI for STEMI, and that has cardiac surgery capability). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed as quickly as possible, with a goal of a [[Door-to-balloon#EMS-to-balloon (E2B)|medical contact-to-balloon]] or [[Door-to-balloon|door-to-balloon]] time within 90 minutes. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed for patients less than 75 years old with ST elevation or presumably new [[LBBB|left bundle-branch block]] who develop shock
within 36 hours of [[MI]] and are suitable for revascularization that can be performed within 18 hours of [[shock]], unless further support is futile because of the patient’s wishes or contraindications/unsuitability for further invasive care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed in patients with severe [[congestive heart failure]] and/or[[pulmonary edema]] ([[Killip class|Killip class 3]]) and onset of symptoms within 12 hours. The[[Door-to-balloon#EMS-to-balloon (E2B)|medical contact-to-balloon]] or [[Door-to-balloon|door-to balloon]] time should be as short as possible (i.e., goal within 90 minutes). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<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.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Elective PCI]] should not be performed in a non-infarct-related artery at the time of primary PCI of the infarct related artery in patients without hemodynamic compromise. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|
<nowiki>"</nowiki>'''2.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Primary PCI]] should not be performed in asymptomatic patients more than 12 hours after onset of [[STEMI]]who are hemodynamically and electrically stable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] is reasonable for selected patients 75 years or older with [[STEMI|ST elevation]]or [[LBBB|left bundle-branch block]] or who develop [[shock]] within 36 hours of [[MI]] and are suitable for revascularization that can be performed within 18 hours of [[shock]]. Patients with good prior functional status who are suitable for revascularization and agree to invasive care may be selected for such an invasive strategy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''2.''' It is reasonable to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] for patients with onset of symptoms within the prior 12 to 24 hours and 1 or more of the following:
 
:'''a.''' Severe [[congestive heart failure]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''b.''' Hemodynamic or electrical instability ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''c.''' Evidence of persistent [[ischemia]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' The benefit of [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] for [[STEMI]] patients eligible for [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]] when performed by an operator who performs fewer than 75 PCI procedures per year (or fewer than 11 PCIs for STEMI per year) is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
=====PCI After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion<ref name="pmid19942100">{{cite journal |author=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 |title=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=[[Journal of the American College of Cardiology]] |volume=54 |issue=23|pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9|accessdate=2011-12-06}}</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.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed when there is objective evidence of recurrent [[MI]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''2.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed for moderate or severe spontaneous or provocable [[myocardial ischemia]] during recovery from STEMI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''3.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed for [[cardiogenic shock]] or hemodynamic instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' It is reasonable to perform routine [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] in patients with [[EF|LV ejection fraction]] less than or equal to 0.40, [[heart failure]], or serious [[ventricular arrhythmias]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''2.''' It is reasonable to perform [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] when there is documented clinical [[heart failure]] during the acute episode, even though subsequent evaluation shows preserved LV function ([[EF|LV ejection fraction]]greater than 0.40). ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]]might be considered as part of an invasive strategy after [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
=====PCI in patients with Prior Coronary Bypass Surgery=====
<ref name="pmid19942100">{{cite journal |author=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 |title=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=[[Journal of the American College of Cardiology]] |volume=54 |issue=23|pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9|accessdate=2011-12-06}}</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.''' When technically feasible, [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] should be performed in patients with early [[ischemia]] (usually within 30 days) after [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' It is recommended that distal embolic protection devices be used when technically feasible in patients undergoing [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] to [[Saphenous vein graft|saphenous vein grafts]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is not recommended in patients with prior [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] for [[Treatment of chronic total occlusions|chronic total vein graft occlusions]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is not recommended in patients who have multiple target lesions with prior [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] and who have [[CAD|multi-vessel disease]],[[Saphenous vein graft#Saphenous Vein Graft Failure and Patency|failure of multiple SVGs]], and[[Left ventricular dysfunction|impaired LV function]] unless repeat [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] poses excessive risk due to severe comorbid conditions. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with [[ischemia]] that occurs 1 to 3 years after [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] and who have preserved LV function with discrete lesions in graft conduits. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with disabling [[Chronic stable angina|angina]] secondary to new disease in a native coronary circulation after [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. (If [[Chronic stable angina|angina]] is not typical, objective evidence of[[ischemia]] should be obtained.) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with diseased [[Saphenous vein graft|vein grafts]] more than 3 years after[[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable when technically feasible in patients with a patent [[LIMA|left internal mammary artery graft]] who have clinically significant obstructions in other vessels. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
=====Revascularization Before Non-cardiac Surgery=====
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine prophylactic [[Chronic stable angina revascularization|coronary revascularization]]should not be performed in patients with [[Chronic stable angina|stable CAD]] before noncardiac surgery.<ref name="pmid16669417">{{cite journal |author=Cinà CS, Devereaux PJ |title=Coronary-artery revascularization before elective major vascular surgery. McFalls EO, ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. N Engl J Med. 2004; 351: 2795-804 |journal=[[Vascular Medicine (London, England)]] |volume=11 |issue=1 |pages=61–3 |year=2006 |month=February |pmid=16669417 |doi=|url=http://vmj.sagepub.com/cgi/pmidlookup?view=long&pmid=16669417|accessdate=2011-12-08}}</ref><ref name="pmid19327412">{{cite journal |author=Schouten O, van Kuijk JP, Flu WJ, Winkel TA, Welten GM, Boersma E, Verhagen HJ, Bax JJ, Poldermans D |title=Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study) |journal=[[The American Journal of Cardiology]] |volume=103 |issue=7 |pages=897–901 |year=2009 |month=April |pmid=19327412|doi=10.1016/j.amjcard.2008.12.018|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(08)02173-5|accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Elective non-cardiac surgery should not be performed in the 4 to 6 weeks after [[balloon angioplasty]] or [[Bare metal stent|BMS implantation]] or the 12 months after [[Drug eluting stent|DES implantation]] in patients in whom the [[Platelet aggregation inhibitor|P2Y12 inhibitor]]will need to be discontinued peri-operatively.<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February|pmid=17291948 |doi=10.1016/j.jacc.2007.01.003|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X|accessdate=2011-12-08}}</ref><ref name="pmid15390248">{{cite journal |author=Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, Lindsay J |title=Major noncardiac surgery following coronary stenting: when is it safe to operate? |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=63|issue=2 |pages=141–5 |year=2004 |month=October |pmid=15390248 |doi=10.1002/ccd.20124|url=http://dx.doi.org/10.1002/ccd.20124 |accessdate=2011-12-08}}</ref><ref name="pmid10758971">{{cite journal |author=Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE|title=Catastrophic outcomes of noncardiac surgery soon after coronary stenting |journal=[[Journal of the American College of Cardiology]] |volume=35 |issue=5 |pages=1288–94 |year=2000 |month=April|pmid=10758971 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00521-0|accessdate=2011-12-08}}</ref><ref name="pmid17488965">{{cite journal |author=Win HK, Caldera AE, Maresh K, Lopez J, Rihal CS, Parikh MA, Granada JF, Marulkar S, Nassif D, Cohen DJ, Kleiman NS|title=Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents|journal=[[JAMA : the Journal of the American Medical Association]] |volume=297 |issue=18|pages=2001–9 |year=2007 |month=May |pmid=17488965 |doi=10.1001/jama.297.18.2001|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17488965 |accessdate=2011-12-08}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' 1. For patients who require [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] and are scheduled for elective non-cardiac surgery in the subsequent 12 months, a strategy of [[balloon angioplasty]], or [[Bare metal stent|BMS implantation]] followed by 4 to 6 weeks of [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]], is reasonable.<ref name="pmid9892591">{{cite journal |author=Berger PB, Bell MR, Hasdai D, Grill DE, Melby S, Holmes DR|title=Safety and efficacy of ticlopidine for only 2 weeks after successful intracoronary stent placement |journal=[[Circulation]] |volume=99 |issue=2 |pages=248–53 |year=1999 |month=January|pmid=9892591 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9892591|accessdate=2011-12-08}}</ref><ref name="pmid20442357">{{cite journal |author=Cruden NL, Harding SA, Flapan AD, Graham C, Wild SH, Slack R, Pell JP, Newby DE |title=Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery |journal=[[Circulation. Cardiovascular Interventions]] |volume=3 |issue=3 |pages=236–42 |year=2010 |month=June |pmid=20442357|doi=10.1161/CIRCINTERVENTIONS.109.934703|url=http://circinterventions.ahajournals.org/cgi/pmidlookup?view=long&pmid=20442357|accessdate=2011-12-08}}</ref><ref name="pmid19926002">{{cite journal |author=Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF |title=2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery |journal=[[Journal of the American College of Cardiology]] |volume=54|issue=22 |pages=e13–e118 |year=2009 |month=November |pmid=19926002 |doi=10.1016/j.jacc.2009.07.010|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02385-7|accessdate=2011-12-08}}</ref><ref name="pmid10758971">{{cite journal |author=Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE |title=Catastrophic outcomes of noncardiac surgery soon after coronary stenting |journal=[[Journal of the American College of Cardiology]] |volume=35 |issue=5|pages=1288–94 |year=2000 |month=April |pmid=10758971 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00521-0|accessdate=2011-12-08}}</ref><ref name="pmid15757604">{{cite journal |author=Reddy PR, Vaitkus PT|title=Risks of noncardiac surgery after coronary stenting |journal=[[The American Journal of Cardiology]] |volume=95 |issue=6 |pages=755–7 |year=2005 |month=March |pmid=15757604|doi=10.1016/j.amjcard.2004.11.029|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(04)01882-X|accessdate=2011-12-08}}</ref><ref name="pmid15390248">{{cite journal |author=Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, Lindsay J |title=Major noncardiac surgery following coronary stenting: when is it safe to operate? |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=63|issue=2 |pages=141–5 |year=2004 |month=October |pmid=15390248 |doi=10.1002/ccd.20124|url=http://dx.doi.org/10.1002/ccd.20124 |accessdate=2011-12-08}}</ref><ref name="pmid12875757">{{cite journal |author=Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, Melby S, Berger PB |title=Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=2 |pages=234–40 |year=2003 |month=July |pmid=12875757 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703006223 |accessdate=2011-12-08}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients with [[Drug eluting stent|drug eluting stent (DES)]] who must undergo urgent surgical procedures that mandate the discontinuation of [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]], it is reasonable to continue [[ST elevation myocardial infarction aspirin therapy|aspirin]] if possible and restart the [[Platelet aggregation inhibitor|P2Y12 inhibitor]] as soon as possible in the immediate postoperative period.<ref name="pmid19926002">{{cite journal |author=Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF |title=2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=22 |pages=e13–e118 |year=2009 |month=November|pmid=19926002 |doi=10.1016/j.jacc.2009.07.010|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02385-7|accessdate=2011-12-08}}</ref><ref name="pmid17950159">{{cite journal |author=Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW |title=ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=17 |pages=1707–32 |year=2007 |month=October |pmid=17950159|doi=10.1016/j.jacc.2007.09.001|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02724-6|accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Adjunctive Therapeutic Devices <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Thrombectomy===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|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.''' [[Thrombectomy|Aspiration thrombectomy]] is reasonable for patients undergoing primary PCI.<ref name="pmid19161878">{{cite journal |author=Sardella G, Mancone M, Bucciarelli-Ducci C, Agati L, Scardala R, Carbone I, Francone M, Di Roma A, Benedetti G, Conti G, Fedele F |title=Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size: the EXPIRA (thrombectomy with export catheter in infarct-related artery during primary percutaneous coronary intervention) prospective, randomized trial |journal=[[Journal of the American College of Cardiology]] |volume=53 |issue=4 |pages=309–15 |year=2009 |month=January|pmid=19161878 |doi=10.1016/j.jacc.2008.10.017|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03542-0|accessdate=2011-12-10}}</ref><ref name="pmid18539223">{{cite journal |author=Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F |title=Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study |journal=[[Lancet]] |volume=371 |issue=9628 |pages=1915–20 |year=2008|month=June |pmid=18539223 |doi=10.1016/S0140-6736(08)60833-8|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60833-8|accessdate=2011-12-10}}</ref><ref name="pmid18812323">{{cite journal |author=Bavry AA, Kumbhani DJ, Bhatt DL |title=Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials |journal=[[European Heart Journal]]|volume=29 |issue=24 |pages=2989–3001 |year=2008 |month=December |pmid=18812323|doi=10.1093/eurheartj/ehn421 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18812323 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
===Laser Angioplasty===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[angioplasty|Laser angioplasty]] should not be used routinely during PCI. <ref name="pmid15028347">{{cite journal |author=Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM|title=Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty |journal=[[Journal of the American College of Cardiology]] |volume=43 |issue=6 |pages=936–42 |year=2004 |month=March |pmid=15028347|doi=10.1016/j.jacc.2003.10.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109704000142|accessdate=2011-12-10}}</ref><ref name="pmid9236422">{{cite journal |author=Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J|title=Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study|journal=[[Circulation]] |volume=96 |issue=1 |pages=91–8 |year=1997 |month=July |pmid=9236422 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9236422|accessdate=2011-12-10}}</ref><ref name="pmid9385898">{{cite journal |author=Stone GW, de Marchena E, Dageforde D, Foschi A, Muhlestein JB, McIvor M, Rizik D, Vanderlaan R, McDonnell J|title=Prospective, randomized, multicenter comparison of laser-facilitated balloon angioplasty versus stand-alone balloon angioplasty in patients with obstructive coronary artery disease. The Laser Angioplasty Versus Angioplasty (LAVA) Trial Investigators |journal=[[Journal of the American College of Cardiology]] |volume=30 |issue=7 |pages=1714–21 |year=1997 |month=December |pmid=9385898|doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109797003872|accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<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.''' [[angioplasty|Laser angioplasty]] might be considered for fibrotic or [[Dystrophic calcification|moderately calcified]] lesions that cannot be crossed or dilated with [[balloon angioplasty|conventional balloon angioplasty]]. <ref name="pmid18324694">{{cite journal|author=Noble S, Bilodeau L |title=High energy excimer laser to treat coronary in-stent restenosis in an underexpanded stent |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=71 |issue=6 |pages=803–7|year=2008 |month=May |pmid=18324694 |doi=10.1002/ccd.21490 |url=http://dx.doi.org/10.1002/ccd.21490|accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Intravenous Antiplatelet Therapy: Sudden Ischemia Heart Disease (SIHD)===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|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.''' In patients undergoing [[Chronic stable angina revascularization percutaneous coronary intervention|elective PCI]] treated with [[Heparin|unfractionated heparin (UFH)]] and not pretreated with [[Chronic stable angina treatment clopidogrel|clopidogrel]], it is reasonable to administer a[[Glycoprotein IIb/IIIa inhibitors|GP IIb/IIIa inhibitor]] ([[abciximab]],[[eptifibatide|double-bolus eptifibatide]], or [[tirofiban|high-bolus dose tirofiban]]).<ref name="pmid15234398">{{cite journal |author=Valgimigli M, Percoco G, Barbieri D, Ferrari F, Guardigli G, Parrinello G, Soukhomovskaia O, Ferrari R |title=The additive value of tirofiban administered with the high-dose bolus in the prevention of ischemic complications during high-risk coronary angioplasty: the ADVANCE Trial |journal=[[Journal of the American College of Cardiology]] |volume=44|issue=1 |pages=14–9 |year=2004 |month=July |pmid=15234398 |doi=10.1016/j.jacc.2004.03.042|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109704007090|accessdate=2011-12-15}}</ref><ref name="pmid9672272">{{cite journal |author= |title=Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade |journal=[[Lancet]] |volume=352 |issue=9122|pages=87–92 |year=1998 |month=July |pmid=9672272 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0140673698061133|accessdate=2011-12-15}}</ref><ref name="pmid11145489">{{cite journal |author= |title=Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial |journal=[[Lancet]] |volume=356 |issue=9247 |pages=2037–44 |year=2000|month=December |pmid=11145489 |doi=10.1016/S0140-6736(00)03400-0|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(00)03400-0|accessdate=2011-12-15}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIb]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients undergoing [[Chronic stable angina revascularization percutaneous coronary intervention|elective PCI]] with [[Stent|stent implantation]] treated with [[Heparin|unfractionated heparin (UFH)]] and adequately pretreated with [[Chronic stable angina treatment clopidogrel|clopidogrel]], it might be reasonable to administer a [[Glycoprotein IIb/IIIa inhibitors|GP IIb/IIIa inhibitor]] ([[abciximab]], [[eptifibatide|double-bolus eptifibatide]], or[[tirofiban|high-bolus dose tirofiban]]).<ref name="pmid15234398">{{cite journal |author=Valgimigli M, Percoco G, Barbieri D, Ferrari F, Guardigli G, Parrinello G, Soukhomovskaia O, Ferrari R|title=The additive value of tirofiban administered with the high-dose bolus in the prevention of ischemic complications during high-risk coronary angioplasty: the ADVANCE Trial |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=1 |pages=14–9 |year=2004 |month=July|pmid=15234398 |doi=10.1016/j.jacc.2004.03.042|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109704007090|accessdate=2011-12-15}}</ref><ref name="pmid14724302">{{cite journal |author=Kastrati A, Mehilli J, Schühlen H, Dirschinger J, Dotzer F, ten Berg JM, Neumann FJ, Bollwein H, Volmer C, Gawaz M, Berger PB, Schömig A |title=A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel |journal=[[The New England Journal of Medicine]] |volume=350|issue=3 |pages=232–8 |year=2004 |month=January |pmid=14724302 |doi=10.1056/NEJMoa031859|url=http://dx.doi.org/10.1056/NEJMoa031859 |accessdate=2011-12-15}}</ref><ref name="pmid15531766">{{cite journal |author=Mehilli J, Kastrati A, Schühlen H, Dibra A, Dotzer F, von Beckerath N, Bollwein H, Pache J, Dirschinger J, Berger PP, Schömig A |title=Randomized clinical trial of abciximab in diabetic patients undergoing elective percutaneous coronary interventions after treatment with a high loading dose of clopidogrel |journal=[[Circulation]] |volume=110|issue=24 |pages=3627–35 |year=2004 |month=December |pmid=15531766|doi=10.1161/01.CIR.0000148956.93631.4D |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15531766 |accessdate=2011-12-15}}</ref><ref name="pmid15485474">{{cite journal|author=Hausleiter J, Kastrati A, Mehilli J, Schühlen H, Pache J, Dotzer F, Glatthor C, Siebert S, Dirschinger J, Schömig A |title=A randomized trial comparing phosphorylcholine-coated stenting with balloon angioplasty as well as abciximab with placebo for restenosis reduction in small coronary arteries |journal=[[Journal of Internal Medicine]] |volume=256 |issue=5 |pages=388–97 |year=2004|month=November |pmid=15485474 |doi=10.1111/j.1365-2796.2004.01398.x|url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0954-6820&date=2004&volume=256&issue=5&spage=388|accessdate=2011-12-15}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Peri-procedural Myocardial Infarction Assessment<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Peri-procedural Myocardial Infarction Assessment===
 
{|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.''' In patients who have [[ST elevation myocardial infarction physical examination|signs]] or[[ST elevation myocardial infarction symptoms|symptoms]] suggestive of [[myocardial infarction]]during or after [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] or in asymptomatic patients with significant persistent angiographic complications (e.g., large side-branch occlusion, flow-limiting dissection, [[no reflow phenomenon]], or [[Coronary stent thrombosis|coronary thrombosis]]), creatinine kinase-MB and troponin I or T should be measured. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' Routine measurement of [[cardiac biomarkers]] (creatinine kinase-MB and/or troponin I or T). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Vascular Closure Devices <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Vascular Closure Devices===
 
{|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.''' Patients considered for vascular closure devices should undergo a femoral angiogram to ensure their anatomic suitability for deployment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' The routine use of vascular closure devices is not recommended for the purpose of decreasing vascular complications, including bleeding.<ref name="pmid20362708">{{cite journal|author=Biancari F, D'Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A |title=Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty |journal=[[American Heart Journal]] |volume=159 |issue=4 |pages=518–31 |year=2010|month=April |pmid=20362708 |doi=10.1016/j.ahj.2009.12.027|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(10)00066-9|accessdate=2011-12-16}}</ref><ref name="pmid17950141">{{cite journal |author=Dauerman HL, Applegate RJ, Cohen DJ |title=Vascular closure devices: the second decade |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=17 |pages=1617–26 |year=2007 |month=October |pmid=17950141|doi=10.1016/j.jacc.2007.07.028|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02457-6|accessdate=2011-12-16}}</ref><ref name="pmid14734598">{{cite journal |author=Koreny M, Riedmüller E, Nikfardjam M, Siostrzonek P, Müllner M |title=Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis|journal=[[JAMA : the Journal of the American Medical Association]] |volume=291 |issue=3|pages=350–7 |year=2004 |month=January |pmid=14734598 |doi=10.1001/jama.291.3.350|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=14734598|accessdate=2011-12-16}}</ref><ref name="pmid20921445">{{cite journal |author=Patel MR, Jneid H, Derdeyn CP, Klein LW, Levine GN, Lookstein RA, White CJ, Yeghiazarians Y, Rosenfield K|title=Arteriotomy closure devices for cardiovascular procedures: a scientific statement from the American Heart Association |journal=[[Circulation]] |volume=122 |issue=18 |pages=1882–93 |year=2010|month=November |pmid=20921445 |doi=10.1161/CIR.0b013e3181f9b345|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=20921445|accessdate=2011-12-16}}</ref><ref name="pmid12847195">{{cite journal |author=Hoffer EK, Bloch RD|title=Percutaneous arterial closure devices |journal=[[Journal of Vascular and Interventional Radiology : JVIR]] |volume=14 |issue=7 |pages=865–85 |year=2003 |month=July |pmid=12847195 |doi=|url= |accessdate=2011-12-16}}</ref><ref name="pmid15364320">{{cite journal |author=Nikolsky E, Mehran R, Halkin A, Aymong ED, Mintz GS, Lasic Z, Negoita M, Fahy M, Krieger S, Moussa I, Moses JW, Stone GW, Leon MB, Pocock SJ, Dangas G |title=Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis|journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=6 |pages=1200–9|year=2004 |month=September |pmid=15364320 |doi=10.1016/j.jacc.2004.06.048|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01323-3|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' The use of vascular closure devices is reasonable for the purposes of achieving faster hemostasis and earlier ambulation compared with the use of manual compression.<ref name="pmid20362708">{{cite journal |author=Biancari F, D'Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A |title=Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty |journal=[[American Heart Journal]] |volume=159|issue=4 |pages=518–31 |year=2010 |month=April |pmid=20362708 |doi=10.1016/j.ahj.2009.12.027|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(10)00066-9|accessdate=2011-12-16}}</ref><ref name="pmid17950141">{{cite journal |author=Dauerman HL, Applegate RJ, Cohen DJ |title=Vascular closure devices: the second decade |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=17 |pages=1617–26 |year=2007 |month=October |pmid=17950141|doi=10.1016/j.jacc.2007.07.028|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02457-6|accessdate=2011-12-16}}</ref><ref name="pmid14734598">{{cite journal |author=Koreny M, Riedmüller E, Nikfardjam M, Siostrzonek P, Müllner M |title=Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis|journal=[[JAMA : the Journal of the American Medical Association]] |volume=291 |issue=3|pages=350–7 |year=2004 |month=January |pmid=14734598 |doi=10.1001/jama.291.3.350|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=14734598|accessdate=2011-12-16}}</ref><ref name="pmid20921445">{{cite journal |author=Patel MR, Jneid H, Derdeyn CP, Klein LW, Levine GN, Lookstein RA, White CJ, Yeghiazarians Y, Rosenfield K|title=Arteriotomy closure devices for cardiovascular procedures: a scientific statement from the American Heart Association |journal=[[Circulation]] |volume=122 |issue=18 |pages=1882–93 |year=2010|month=November |pmid=20921445 |doi=10.1161/CIR.0b013e3181f9b345|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=20921445|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Post-procedural Antiplatelet Therapy <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Post-procedural Antiplatelet Therapy===
 
{|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.''' After PCI, use of [[aspirin]] should be continued indefinitely.<ref name="pmid8598866">{{cite journal |author=Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M, Walter H, Zitzmann-Roth EM, Richardt G, Alt E, Schmitt C, Ulm K |title=A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents|journal=[[The New England Journal of Medicine]] |volume=334 |issue=17 |pages=1084–9 |year=1996|month=April |pmid=8598866 |doi=10.1056/NEJM199604253341702|url=http://dx.doi.org/10.1056/NEJM199604253341702 |accessdate=2011-12-16}}</ref><ref name="pmid11786451">{{cite journal |author= |title=Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients |journal=[[BMJ (Clinical Research Ed.)]] |volume=324 |issue=7329 |pages=71–86 |year=2002|month=January |pmid=11786451 |pmc=64503 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=11786451 |accessdate=2011-12-16}}</ref><ref name="pmid16702489">{{cite journal|author=Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA |title=AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute |journal=[[Circulation]]|volume=113 |issue=19 |pages=2363–72 |year=2006 |month=May |pmid=16702489|doi=10.1161/CIRCULATIONAHA.106.174516 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16702489 |accessdate=2011-12-16}}</ref><ref name="pmid19482214">{{cite journal|author=Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A |title=Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials |journal=[[Lancet]] |volume=373 |issue=9678 |pages=1849–60 |year=2009|month=May |pmid=19482214 |pmc=2715005 |doi=10.1016/S0140-6736(09)60503-1|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(09)60503-1|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' The duration of [[Antiplatelet drug|P2Y12 inhibitor therapy]] after [[Stent|stent implantation]] should generally be as follows:
 
:'''a.''' In patients receiving a [[stent]] ([[Bare metal stent|bare metal stent (BMS)]] or [[Drug eluting stent| drug eluting stent (DES)]]) during PCI for [[ACS]], [[Antiplatelet drug|P2Y12 inhibitor therapy]] should be given for at least 12 months. Options include [[clopidogrel|clopidogrel 75 mg daily]] <ref name="pmid11520521">{{cite journal|author=Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H, Zhao F, Chrolavicius S, Copland I, Fox KA |title=Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study |journal=[[Lancet]] |volume=358 |issue=9281 |pages=527–33 |year=2001 |month=August|pmid=11520521 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673601057014|accessdate=2011-12-16}}</ref>, [[prasugrel|prasugrel 10 mg daily]] <ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM|title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20 |pages=2001–15 |year=2007 |month=November|pmid=17982182 |doi=10.1056/NEJMoa0706482 |url=http://dx.doi.org/10.1056/NEJMoa0706482|accessdate=2011-12-16}}</ref>, and [[ticagrelor|ticagrelor 90 mg twice daily]].<ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11|pages=1045–57 |year=2009 |month=September |pmid=19717846 |doi=10.1056/NEJMoa0904327|url=http://dx.doi.org/10.1056/NEJMoa0904327 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' In patients receiving [[Drug eluting stent| drug eluting stent (DES)]] for a non-ACS indication, [[clopidogrel|clopidogrel 75 mg daily]] should be given for at least 12 months if the patient is not at high risk of bleeding.<ref name="pmid18534267">{{cite journal |author=Brar SS, Kim J, Brar SK, Zadegan R, Ree M, Liu IL, Mansukhani P, Aharonian V, Hyett R, Shen AY |title=Long-term outcomes by clopidogrel duration and stent type in a diabetic population with de novo coronary artery lesions |journal=[[Journal of the American College of Cardiology]] |volume=51 |issue=23|pages=2220–7 |year=2008 |month=June |pmid=18534267 |doi=10.1016/j.jacc.2008.01.063|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)01051-6|accessdate=2011-12-16}}</ref><ref name="pmid17148711">{{cite journal |author=Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, Kramer JM, Harrington RA, Matchar DB, Kandzari DE, Peterson ED, Schulman KA, Califf RM |title=Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation |journal=[[JAMA : the Journal of the American Medical Association]]|volume=297 |issue=2 |pages=159–68 |year=2007 |month=January |pmid=17148711|doi=10.1001/jama.297.2.joc60179 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17148711 |accessdate=2011-12-16}}</ref><ref name="pmid17291948">{{cite journal|author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P|title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians|journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9|year=2007 |month=February |pmid=17291948 |doi=10.1016/j.jacc.2007.01.003|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''c.''' In patients receiving [[Bare metal stent|bare metal stent (BMS)]] for a non-ACS indication, [[clopidogrel]] should be given for a minimum of 1 month and ideally up to 12 months (unless the patient is at increased risk of bleeding; then it should be given for a minimum of 2 weeks).<ref name="pmid12435254">{{cite journal |author=Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C, Topol EJ |title=Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=288 |issue=19 |pages=2411–20 |year=2002 |month=November|pmid=12435254 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12435254|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients should be counseled on the importance of compliance with [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] and that therapy should not be discontinued before discussion with their cardiologist.<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February|pmid=17291948 |doi=10.1016/j.jacc.2007.01.003|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Continuation of [[clopidogrel]], [[prasugrel]] or [[ticagrelor]] beyond 12 months may be considered in patients undergoing placement of [[Drug eluting stent| drug eluting stent (DES)]].<ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes|journal=[[The New England Journal of Medicine]] |volume=357 |issue=20 |pages=2001–15 |year=2007|month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482|url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-16}}</ref><ref name="pmid19717846">{{cite journal |author=Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=361 |issue=11|pages=1045–57 |year=2009 |month=September |pmid=19717846 |doi=10.1056/NEJMoa0904327|url=http://dx.doi.org/10.1056/NEJMoa0904327 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' After PCI, it is reasonable to use [[aspirin]] 81 mg per day in preference to higher maintenance doses.<ref name="pmid18819961">{{cite journal |author=Jolly SS, Pogue J, Haladyn K, Peters RJ, Fox KA, Avezum A, Gersh BJ, Rupprecht HJ, Yusuf S, Mehta SR |title=Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study |journal=[[European Heart Journal]] |volume=30 |issue=8 |pages=900–7 |year=2009|month=April |pmid=18819961 |doi=10.1093/eurheartj/ehn417|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18819961|accessdate=2011-12-16}}</ref><ref name="pmid18574266">{{cite journal |author=Patrono C, Baigent C, Hirsh J, Roth G |title=Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=[[Chest]] |volume=133 |issue=6 Suppl|pages=199S–233S |year=2008 |month=June |pmid=18574266 |doi=10.1378/chest.08-0672|url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574266|accessdate=2011-12-16}}</ref><ref name="pmid19293071">{{cite journal |author=Steinhubl SR, Bhatt DL, Brennan DM, Montalescot G, Hankey GJ, Eikelboom JW, Berger PB, Topol EJ |title=Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding |journal=[[Annals of Internal Medicine]] |volume=150 |issue=6 |pages=379–86 |year=2009|month=March |pmid=19293071 |doi= |url= |accessdate=2011-12-16}}</ref><ref name="pmid15877994">{{cite journal |author=Serebruany VL, Steinhubl SR, Berger PB, Malinin AI, Baggish JS, Bhatt DL, Topol EJ |title=Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials |journal=[[The American Journal of Cardiology]] |volume=95 |issue=10 |pages=1218–22 |year=2005 |month=May|pmid=15877994 |doi=10.1016/j.amjcard.2005.01.049|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(05)00294-8|accessdate=2011-12-16}}</ref><ref name="pmid14504182">{{cite journal |author=Peters RJ, Mehta SR, Fox KA, Zhao F, Lewis BS, Kopecky SL, Diaz R, Commerford PJ, Valentin V, Yusuf S |title=Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study |journal=[[Circulation]] |volume=108 |issue=14 |pages=1682–7 |year=2003 |month=October|pmid=14504182 |doi=10.1161/01.CIR.0000091201.39590.CB|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14504182|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by a recommended duration of [[Antiplatelet drug|P2Y12 inhibitor therapy]] after [[stent|stent implantation]], earlier discontinuation (e.g., less than 12 months) of [[Antiplatelet drug|P2Y12 inhibitor therapy]] is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Proton Pump Inhibitors and Anti-platelet Therapy===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</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.''' [[Proton pump inhibitors]] should be used in patients with a history of prior[[gastrointestinal bleeding]] who require [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]].<ref name="pmid21126648">{{cite journal |author=Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, Furberg CD, Johnson DA, Kahi CJ, Laine L, Mahaffey KW, Quigley EM, Scheiman J, Sperling LS, Tomaselli GF |title=ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents|journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=24 |pages=2051–66|year=2010 |month=December |pmid=21126648 |doi=10.1016/j.jacc.2010.09.010|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03972-0|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine use of a [[proton pump inhibitor]] is not recommended for patients at low risk of[[gastrointestinal bleeding]], who have much less potential to benefit from prophylactic therapy.<ref name="pmid21126648">{{cite journal |author=Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, Furberg CD, Johnson DA, Kahi CJ, Laine L, Mahaffey KW, Quigley EM, Scheiman J, Sperling LS, Tomaselli GF |title=ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents|journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=24 |pages=2051–66|year=2010 |month=December |pmid=21126648 |doi=10.1016/j.jacc.2010.09.010|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03972-0|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Use of [[proton pump inhibitors]] is reasonable in patients with an increased risk of[[gastrointestinal bleeding]] (e.g., advanced age, concomitant use of [[warfarin]], [[steroids]],[[NSAID|nonsteroidal antiinflammatory drugs]], [[Helicobacter pylori|Helicobacter pylori infection]]) who require [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]].<ref name="pmid21126648">{{cite journal |author=Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, Furberg CD, Johnson DA, Kahi CJ, Laine L, Mahaffey KW, Quigley EM, Scheiman J, Sperling LS, Tomaselli GF |title=ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents|journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=24 |pages=2051–66|year=2010 |month=December |pmid=21126648 |doi=10.1016/j.jacc.2010.09.010|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03972-0|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Clopidogrel Genetic Testing===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' The routine clinical use of genetic testing to screen patients treated with [[clopidogrel]]who are undergoing PCI is not recommended.<ref name="pmid20633831">{{cite journal |author=Holmes DR, Dehmer GJ, Kaul S, Leifer D, O'Gara PT, Stein CM |title=ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons|journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=4 |pages=321–41|year=2010 |month=July |pmid=20633831 |doi=10.1016/j.jacc.2010.05.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01997-2|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' Genetic testing might be considered to identify whether a patient at high risk for poor clinical outcomes is predisposed to inadequate platelet inhibition with [[clopidogrel]].<ref name="pmid20633831">{{cite journal |author=Holmes DR, Dehmer GJ, Kaul S, Leifer D, O'Gara PT, Stein CM |title=ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=4 |pages=321–41 |year=2010 |month=July |pmid=20633831|doi=10.1016/j.jacc.2010.05.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01997-2|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' When a patient predisposed to inadequate platelet inhibition with [[clopidogrel]] is identified by genetic testing, treatment with an alternate [[Platelet aggregation inhibitor|P2Y12 inhibitor]] (e.g., [[prasugrel]] or [[ticagrelor]]) might be considered.<ref name="pmid20633831">{{cite journal |author=Holmes DR, Dehmer GJ, Kaul S, Leifer D, O'Gara PT, Stein CM |title=ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=4 |pages=321–41 |year=2010 |month=July |pmid=20633831|doi=10.1016/j.jacc.2010.05.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01997-2|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Platelet Function Testing===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' The routine clinical use of platelet function testing to screen patients treated with[[clopidogrel]] who are undergoing PCI is not recommended.<ref name="pmid20633831">{{cite journal|author=Holmes DR, Dehmer GJ, Kaul S, Leifer D, O'Gara PT, Stein CM |title=ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=4|pages=321–41 |year=2010 |month=July |pmid=20633831 |doi=10.1016/j.jacc.2010.05.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01997-2|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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.''' Platelet function testing may be considered in patients at high risk for poor clinical outcomes.<ref name="pmid20633831">{{cite journal |author=Holmes DR, Dehmer GJ, Kaul S, Leifer D, O'Gara PT, Stein CM |title=ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=4 |pages=321–41 |year=2010 |month=July|pmid=20633831 |doi=10.1016/j.jacc.2010.05.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01997-2|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In patients treated with [[clopidogrel]] with high platelet reactivity, alternative agents, such as [[prasugrel]] or [[ticagrelor]], might be considered.<ref name="pmid20633831">{{cite journal|author=Holmes DR, Dehmer GJ, Kaul S, Leifer D, O'Gara PT, Stein CM |title=ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=4|pages=321–41 |year=2010 |month=July |pmid=20633831 |doi=10.1016/j.jacc.2010.05.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01997-2|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Restenosis <ref name="pmid22070837">{{cite journal|author=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 |title=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|journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Restenosis===
The restenosis rates are 30-40%.
 
{|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.''' Patients who develop clinical [[restenosis]] after [[balloon angioplasty]] should be treated with [[bare metal stent|bare metal stent (BMS)]] or [[drug eluting stent|drug eluting stent (DES)]] if anatomic factors are appropriate and if the patient is able to comply with and tolerate[[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]].<ref name="pmid9834304">{{cite journal |author=Erbel R, Haude M, Höpp HW, Franzen D, Rupprecht HJ, Heublein B, Fischer K, de Jaegere P, Serruys P, Rutsch W, Probst P |title=Coronary-artery stenting compared with balloon angioplasty for restenosis after initial balloon angioplasty. Restenosis Stent Study Group|journal=[[The New England Journal of Medicine]] |volume=339 |issue=23 |pages=1672–8 |year=1998|month=December |pmid=9834304 |doi=10.1056/NEJM199812033392304|url=http://dx.doi.org/10.1056/NEJM199812033392304 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients who develop clinical [[restenosis]] after [[bare metal stent|bare metal stent (BMS)]] should be treated with [[drug eluting stent|drug eluting stent (DES)]] if anatomic factors are appropriate and the patient is able to comply with and tolerate [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]].<ref name="pmid16531619">{{cite journal |author=Holmes DR, Teirstein P, Satler L, Sketch M, O'Malley J, Popma JJ, Kuntz RE, Fitzgerald PJ, Wang H, Caramanica E, Cohen SA|title=Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: the SISR randomized trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=295 |issue=11 |pages=1264–73 |year=2006 |month=March |pmid=16531619|doi=10.1001/jama.295.11.1264 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16531619|accessdate=2011-12-16}}</ref><ref name="pmid17276188">{{cite journal |author=Dibra A, Kastrati A, Alfonso F, Seyfarth M, Pérez-Vizcayno MJ, Mehilli J, Schömig A |title=Effectiveness of drug-eluting stents in patients with bare-metal in-stent restenosis: meta-analysis of randomized trials|journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=5 |pages=616–23|year=2007 |month=February |pmid=17276188 |doi=10.1016/j.jacc.2006.10.049|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)02882-8|accessdate=2011-12-16}}</ref><ref name="pmid15644543">{{cite journal |author=Kastrati A, Mehilli J, von Beckerath N, Dibra A, Hausleiter J, Pache J, Schühlen H, Schmitt C, Dirschinger J, Schömig A|title=Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial|journal=[[JAMA : the Journal of the American Medical Association]] |volume=293 |issue=2|pages=165–71 |year=2005 |month=January |pmid=15644543 |doi=10.1001/jama.293.2.165|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15644543 |accessdate=2011-12-16}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Patients who develop clinical [[restenosis]] after [[drug eluting stent|drug eluting stent (DES)]] may be considered for repeat PCI with [[balloon angioplasty]], [[bare metal stent|bare metal stent (BMS)]], or [[drug eluting stent|drug eluting stent (DES)]] containing the same drug or an alternative antiproliferative drug if anatomic factors are appropriate and the patient is able to comply with and tolerate [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]].<ref name="pmid21109112">{{cite journal |author=Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R |title=In-stent restenosis in the drug-eluting stent era |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=23 |pages=1897–907 |year=2010 |month=November|pmid=21109112 |doi=10.1016/j.jacc.2010.07.028|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03986-0|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[IVUS]] is reasonable to determine the mechanism of [[restenosis|stent restenosis]].<ref name="pmid21109112">{{cite journal |author=Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R |title=In-stent restenosis in the drug-eluting stent era |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=23 |pages=1897–907 |year=2010 |month=November|pmid=21109112 |doi=10.1016/j.jacc.2010.07.028|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03986-0|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Exercise Testing===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine periodic stress testing of asymptomatic patients after PCI without specific clinical indications should not be performed.<ref name="pmid15019882">{{cite journal|author=Eisenberg MJ, Blankenship JC, Huynh T, Azrin M, Pathan A, Sedlis S, Panja M, Starling MR, Beyar R, Azoulay A, Caron J, Pilote L |title=Evaluation of routine functional testing after percutaneous coronary intervention |journal=[[The American Journal of Cardiology]] |volume=93|issue=6 |pages=744–7 |year=2004 |month=March |pmid=15019882 |doi=10.1016/j.amjcard.2003.11.071|url=http://linkinghub.elsevier.com/retrieve/pii/S000291490301717X |accessdate=2011-12-16}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients entering a formal cardiac rehabilitation program after PCI, treadmill exercise testing is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Cardiac Rehabilitation===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</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.''' Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.<ref name="pmid21576654">{{cite journal |author=Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ |title=Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community |journal=[[Circulation]] |volume=123|issue=21 |pages=2344–52 |year=2011 |month=May |pmid=21576654 |doi=10.1161/CIRCULATIONAHA.110.983536|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21576654|accessdate=2011-12-16}}</ref><ref name="pmid15121495">{{cite journal |author=Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N|title=Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials |journal=[[The American Journal of Medicine]]|volume=116 |issue=10 |pages=682–92 |year=2004 |month=May |pmid=15121495|doi=10.1016/j.amjmed.2004.01.009 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002934304001238|accessdate=2011-12-16}}</ref><ref name="pmid19001195">{{cite journal |author=Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, Chieffo C, Gattone M, Griffo R, Schweiger C, Tavazzi L, Urbinati S, Valagussa F, Vanuzzo D |title=Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network|journal=[[Archives of Internal Medicine]] |volume=168 |issue=20 |pages=2194–204 |year=2008|month=November |pmid=19001195 |doi=10.1001/archinte.168.20.2194|url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=19001195|accessdate=2011-12-16}}</ref><ref name="pmid15337208">{{cite journal |author=Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL |title=Cardiac rehabilitation after myocardial infarction in the community |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=5 |pages=988–96 |year=2004 |month=September |pmid=15337208|doi=10.1016/j.jacc.2004.05.062|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01142-8|accessdate=2011-12-16}}</ref><ref name="pmid11581152">{{cite journal |author=Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T |title=Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association |journal=[[Circulation]]|volume=104 |issue=14 |pages=1694–740 |year=2001 |month=October |pmid=11581152 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11581152|accessdate=2011-12-16}}</ref><ref name="pmid12909570">{{cite journal |author=Thompson PD|title=Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease |journal=[[Arteriosclerosis, Thrombosis, and Vascular Biology]] |volume=23|issue=8 |pages=1319–21 |year=2003 |month=August |pmid=12909570|doi=10.1161/01.ATV.0000087143.33998.F2 |url=http://atvb.ahajournals.org/cgi/pmidlookup?view=long&pmid=12909570 |accessdate=2011-12-16}}</ref><ref name="pmid16263889">{{cite journal|author=Clark AM, Hartling L, Vandermeer B, McAlister FA |title=Meta-analysis: secondary prevention programs for patients with coronary artery disease |journal=[[Annals of Internal Medicine]]|volume=143 |issue=9 |pages=659–72 |year=2005 |month=November |pmid=16263889 |doi= |url=|accessdate=2011-12-16}}</ref><ref name="pmid17903645">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Bonow RO, Estes NA, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=50|issue=14 |pages=1400–33 |year=2007 |month=October |pmid=17903645 |doi=10.1016/j.jacc.2007.04.033|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)01339-3|accessdate=2011-12-16}}</ref><ref name="pmid18277195">{{cite journal |author=Walther C, Möbius-Winkler S, Linke A, Bruegel M, Thiery J, Schuler G, Halbrecht R |title=Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease |journal=[[European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology]] |volume=15 |issue=1 |pages=107–12 |year=2008 |month=February |pmid=18277195|doi=10.1097/HJR.0b013e3282f29aa6 |url=http://cpr.sagepub.com/cgi/pmidlookup?view=long&pmid=18277195|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Quality and Performance Considerations <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Quality and Performance===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</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.''' Every PCI program should operate a quality-improvement program that routinely
 
:'''i.''' reviews quality and outcomes of the entire program; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''ii.''' reviews results of individual operators; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''iii.''' includes risk adjustment; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''iv.''' provides peer review of difficult or complicated cases; and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''v.''' performs random case reviews. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Every PCI program should participate in a regional or national PCI registry for the purpose of benchmarking its outcomes against current national norms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Certification and Maintenance of Certification===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>
 
{|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.''' It is reasonable for all physicians who perform PCI to participate in the American Board of Internal Medicine interventional cardiology board certification and maintenance of certification program. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
===Operator and Institutional Competency and Volume===
<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</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.''' Elective/urgent PCI should be performed by operators with an acceptable annual volume (greater than or equal to 75 procedures) at high-volume centers (more than 400 procedures) with on-site [[cardiac surgery]].<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH |title=Volume-outcome relationships for percutaneous coronary interventions in the stent era |journal=[[Circulation]]|volume=112 |issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref><ref name="pmid20511324">{{cite journal|author=Post PN, Kuijpers M, Ebels T, Zijlstra F |title=The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis |journal=[[European Heart Journal]]|volume=31 |issue=16 |pages=1985–92 |year=2010 |month=August |pmid=20511324|doi=10.1093/eurheartj/ehq151 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20511324 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Elective/urgent PCI should be performed by operators and institutions whose current risk-adjusted outcomes statistics are comparable to those reported in contemporary national data registries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] for [[STEMI]] should be performed by experienced operators who perform more than 75 [[ST elevation myocardial infarction primary percutaneous coronary intervention|elective PCI]] procedures per year and, ideally, at least 11 [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] procedures for [[STEMI]] per year. Ideally, these procedures should be performed in institutions that perform more than 400 [[ST elevation myocardial infarction primary percutaneous coronary intervention|elective PCIs]] per year and more than 36 [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] procedures for[[STEMI]] per year.<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH |title=Volume-outcome relationships for percutaneous coronary interventions in the stent era |journal=[[Circulation]] |volume=112|issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref><ref name="pmid10865271">{{cite journal|author=Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, Gore JM, Weaver WD, Rogers WJ, Tiefenbrunn AJ |title=Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction |journal=[[JAMA :the Journal of the American Medical Association]] |volume=283 |issue=22 |pages=2941–7 |year=2000|month=June |pmid=10865271 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=10865271 |accessdate=2011-12-16}}</ref><ref name="pmid10824077">{{cite journal|author=Canto JG, Every NR, Magid DJ, Rogers WJ, Malmgren JA, Frederick PD, French WJ, Tiefenbrunn AJ, Misra VK, Kiefe CI, Barron HV |title=The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators|journal=[[The New England Journal of Medicine]] |volume=342 |issue=21 |pages=1573–80 |year=2000|month=May |pmid=10824077 |doi=10.1056/NEJM200005253422106|url=http://dx.doi.org/10.1056/NEJM200005253422106 |accessdate=2011-12-16}}</ref><ref name="pmid19215830">{{cite journal |author=Srinivas VS, Hailpern SM, Koss E, Monrad ES, Alderman MH|title=Effect of physician volume on the relationship between hospital volume and mortality during primary angioplasty |journal=[[Journal of the American College of Cardiology]] |volume=53 |issue=7|pages=574–9 |year=2009 |month=February |pmid=19215830 |doi=10.1016/j.jacc.2008.09.056|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03799-6|accessdate=2011-12-16}}</ref><ref name="pmid11684626">{{cite journal |author=Vakili BA, Kaplan R, Brown DL |title=Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in New York state |journal=[[Circulation]] |volume=104 |issue=18|pages=2171–6 |year=2001 |month=October |pmid=11684626 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11684626|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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]] (No Benefit)
 
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' It is not recommended that elective/urgent PCI be performed by low-volume operators (75 procedures per year) at low-volume centers (200 to 400 procedures per year) with or without on-site [[cardiac surgery]]. An institution with a volume of fewer than 200 procedures per year, unless in a region that is underserved because of geography, should carefully consider whether it should continue to offer this service.<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH|title=Volume-outcome relationships for percutaneous coronary interventions in the stent era|journal=[[Circulation]] |volume=112 |issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable that operators with acceptable volume (75 PCI procedures per year) perform elective/urgent PCI at low-volume centers (200 to 400 PCI procedures per year) with on-site[[cardiac surgery]].<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH |title=Volume-outcome relationships for percutaneous coronary interventions in the stent era |journal=[[Circulation]] |volume=112|issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable that low-volume operators (75 PCI procedures per year) perform elective/urgent PCI at high-volume centers (more than 400 PCI procedures per year) with on-site cardiac surgery. Ideally, operators with an annual procedure volume of fewer than 75 procedures per year should only work at institutions with an activity level of more than 600 procedures per year. Operators who perform fewer than 75 procedures per year should develop a defined mentoring relationship with a highly experienced operator who has an annual procedural volume of at least 150 procedures. ''([[ACC AHA guidelines classification scheme#Level of Evidence|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 IIa]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The benefit of [[ST elevation myocardial infarction primary percutaneous coronary intervention|primary PCI]] for [[STEMI]] patients eligible for [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]] when performed by an operator who performs fewer than 75 procedures per year (11 [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCIs]] for [[STEMI]] per year) is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
==Guideline Resources==
*[http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf 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]<ref name="pmid22070834">{{cite journal |author=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 |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. 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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=e44–122 |year=2011 |month=December |pmid=22070834 |doi=10.1016/j.jacc.2011.08.007 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02876-2 |accessdate=2012-03-16}}</ref>
 
*[http://content.onlinejacc.org/cgi/reprint/54/23/2205.pdf 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)]<ref name="pmid19942100">Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19942100 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.] ''J Am Coll Cardiol'' 54 (23):2205-41. [http://dx.doi.org/10.1016/j.jacc.2009.10.015 DOI:10.1016/j.jacc.2009.10.015] PMID:[http://pubmed.gov/19942100 19942100]</ref>
 
==References==
{{reflist|2}}
 
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