Percutaneous coronary intervention (PCI): Difference between revisions

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(/* 2011 ACCF/AHA/SCAI Guideline Recommendations: Post-procedural Antiplatelet Therapy {{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, Ma...)
(/* 2011 ACCF/AHA/SCAI Guideline Recommendations: Restenosis {{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,...)
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==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>==
==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===  
===Exercise Testing===  

Revision as of 15:02, 11 October 2012

Percutaneous Coronary Intervention Guidelines Microchapters

Home

Patient Information

Overview

PCI Approaches:

CAD Revascularization:

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

Pre-procedural Considerations:

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

Procedural Considerations:

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

Post-Procedural Considerations:

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

Quality and Performance Considerations:

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

Percutaneous coronary intervention (PCI) On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [12]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [13]

Synonyms and keywords: PCI; balloon angioplasty; percutaneous transluminal angioplasty

Overview

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty, is an invasive cardiologic therapeutic procedure to treat the stenotic (narrowed) 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 (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 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[1]

Class III (Harm)

"1. PCI to improve survival should not be performed in stable patients with significant (greater than or equal to 50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG. [2][3][4][5][6][7][8][9][10][11] (Level of Evidence: B)"

Class IIa

"1. PCI to improve survival is reasonable as an alternative to CABG in selected stable patients with significant (greater than or equal to 50% diameter stenosis) unprotected left main CAD with:

a. Anatomic conditions associated with a low risk of 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 (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%). [2][3][4][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] (Level of Evidence: B)"

"2. PCI to improve survival is reasonable in patients with UA/NSTEMI when an unprotected left main coronary artery is the culprit lesion and the patient is not a candidate for CABG. [4][18][30][20][21][26][27][28][29][31] (Level of Evidence: B)"

"3. PCI to improve survival is reasonable in patients with acute STEMI when an unprotected left main coronary artery is the culprit lesion, distal coronary flow is less than TIMI (Thrombolysis In Myocardial Infarction) grade 3, and PCI can be performed more rapidly and safely than CABG. [15][32][33] (Level of Evidence: C)"

Class IIb

"1. PCI to improve survival may be reasonable as an alternative to CABG in selected stablepatients with significant (greater than or equal to 50% diameter stenosis) unprotected left main CAD with:

a. Anatomic conditions associated with a low to intermediate risk of PCI procedural complicationsand an intermediate to high likelihood of good long-term outcome (e.g., low-intermediateSYNTAX score of lower than 33, bifurcation left main CAD); and (Level of Evidence: B)
b. Clinical characteristics that predict an increased risk of adverse surgical outcomes (e.g., moderate-severe chronic obstructive pulmonary disease, disability from previous stroke, or previous cardiac surgery; Society of Thoracic Surgeons–predicted risk of operative mortality greater than 2%). [2][3][4][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][34] (Level of Evidence: B)"

ACCF/AHA Guidelines for Revascularization to Improve Survival: Non-Left Main Coronary Artery Disease[1]

Class I

"1. CABG or PCI to improve survival is beneficial in survivors of sudden cardiac deathwith presumed ischemia-mediated ventricular tachycardia caused by significant (greater than or equal to 70% diameter) stenosis in a major coronary artery. (CABG (Level of Evidence: B) [35][36][37]; PCI (Level of Evidence: C) [35])"

Class III (Harm)

"1. CABG or PCI should not be performed with the primary or sole intent to improve survival in patients with stable ischemic heart disease with 1 or morecoronary stenoses that are not anatomically or functionally significant (e.g., greater than 70% diameter non–left main coronary artery stenosis, fractional flow reserve 0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. [11][38][39][40][41][42][43][44][45](Level of Evidence: B)"

Class IIa

"1. It is reasonable to choose CABG over PCI to improve survival in patients with complex3-vessel CAD (e.g., SYNTAX score greater than 22) with or without involvement of the proximal LAD artery who are good candidates for CABG. [46][47][14][12][48] (Level of Evidence: B)"

"2. CABG is probably recommended in preference to PCI to improve survival in patients withmultivessel CAD and diabetes mellitus, particularly if a left internal mammary artery graft can be anastomosed to the LAD artery. [49][50][51][52][48][53][54][55][56] (Level of Evidence: B)"

Class IIb

"1. The usefulness of PCI to improve survival is uncertain in patients with 2- or 3-vessel CAD (with or without involvement of the proximal LAD artery) or 1-vessel proximal LAD disease. [7][38][46][57] (Level of Evidence: B)"

"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. [58][59][60][61][62][63][64][65][66] (Level of Evidence: B)"

ACCF/AHA Guidelines for Revascularization to Improve Symptoms[1]

Class I

"1. CABG orPCI to improve symptoms is beneficial in patients with 1 or more significant (greater than 70% diameter) coronary artery stenoses amenable to revascularization and unacceptable angina despite guideline-directed medical therapy. [57][67][68][69][70][71][72][73][74][75][76] (Level of Evidence: A)"

Class III (Harm)

"1. CABG orPCI 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 revascularization. (Level of Evidence: C)"

Class IIa

"1. CABG orPCI to improve symptoms is reasonable in patients with 1 or more significant (greater than 70% diameter) coronary artery stenoses and unacceptable angina for whom guideline-directed medical therapy cannot be implemented because of medication contraindications, adverse effects, or patient preferences. (Level of Evidence: C)"

"2. PCI to improve symptoms is reasonable in patients with previous CABG, 1 or more significant (greater than 70% diameter) coronary artery stenoses associated with ischemia, and unacceptable anginadespite guideline-directed medical therapy. [59][62][65] (Level of Evidence: C)"

"3. It is reasonable to choose CABG over PCI to improve symptoms in patients with complex 3-vessel CAD (e.g.,SYNTAX score greater than 22), with or without involvement of the proximal LAD artery who are good candidates for CABG. [14][12][47][48](Level of Evidence: B)"

Class IIb

"1. 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 PCI, and unacceptable angina despite guideline-directed medical therapy. [66] (Level of Evidence: C)"

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:

Balloon angioplasty is now used to facilitate stent deployment.

2011 ACCF/AHA/SCAI Guideline Recommendations: Procedural Considerations [1]

ACCF/AHA Guidelines for PCI in patients with Stable Ischemic Heart Disease (SIHD)[77]

PCI in patients with ST-Elevation Myocardial Infarction[1]

Coronary Angiography Strategies in STEMI[1]
Class I

"1. A strategy of immediate coronary angiography with intent to perform PCI (or emergency CABG) in patients with STEMI is recommended for:

a. Patients who are candidates for primary PCI.[78][79][80][81][82] (Level of Evidence: A)
b. Patients with severe heart failure or cardiogenic shock who are suitable candidates for revascularization.[83][84] (Level of Evidence: B)"
Class IIa

"1. A strategy of immediate coronary angiography (or transfer for immediate coronary angiography) with intent to perform PCI is reasonable for patients with STEMI, a moderate to large area of myocardium at risk, and evidence of failed fibrinolysis.[85][86] (Level of Evidence: B)"

"2. A strategy of coronary angiography (or transfer for coronary angiography) 3 to 24 hours after initiating fibrinolytic therapy with intent to perform PCI is reasonable for hemodynamically stable patients with STEMI and evidence for successful fibrinolysis when angiography and revascularization can be performed as soon as logistically feasible in this time frame.[87][88][89][90][91] (Level of Evidence: A)"

Patients With STEMI: General and Specific Considerations[77]
Class I

"1. If immediately available, primary PCI should be performed in patients with STEMI(including true posterior MI) or MI with new or presumably new 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). (Level of Evidence: A) Primary PCI should be performed as quickly as possible, with a goal of a medical contact-to-balloon or door-to-balloon time within 90 minutes. (Level of Evidence: B)"

"2. Primary PCI should be performed for patients less than 75 years old with ST elevation or presumably new 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. (Level of Evidence: A)"

"3. Primary PCI should be performed in patients with severe congestive heart failure and/orpulmonary edema (Killip class 3) and onset of symptoms within 12 hours. Themedical contact-to-balloon or door-to balloon time should be as short as possible (i.e., goal within 90 minutes). (Level of Evidence: B)"

Class III

"1. 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. (Level of Evidence: C)"

"2. Primary PCI should not be performed in asymptomatic patients more than 12 hours after onset of STEMIwho are hemodynamically and electrically stable. (Level of Evidence: C)"

Class IIa

"1. Primary PCI is reasonable for selected patients 75 years or older with ST elevationor 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. (Level of Evidence: B)"

"2. It is reasonable to perform 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 (Level of Evidence: C)
b. Hemodynamic or electrical instability (Level of Evidence: C)
c. Evidence of persistent ischemia (Level of Evidence: C)"
Class IIb

"1. The benefit of primary PCI for STEMI patients eligible for 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.(Level of Evidence: C)"

PCI After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion[77]
Class I

"1. In patients whose anatomy is suitable, PCI should be performed when there is objective evidence of recurrent MI. (Level of Evidence: C)"

"2. In patients whose anatomy is suitable, PCI should be performed for moderate or severe spontaneous or provocable myocardial ischemia during recovery from STEMI. (Level of Evidence: B)"

"3. In patients whose anatomy is suitable, PCI should be performed for cardiogenic shock or hemodynamic instability. (Level of Evidence: B)"

Class IIa

"1. It is reasonable to perform routine PCI in patients with LV ejection fraction less than or equal to 0.40, heart failure, or serious ventricular arrhythmias. (Level of Evidence: C)"

"2. It is reasonable to perform PCI when there is documented clinical heart failure during the acute episode, even though subsequent evaluation shows preserved LV function (LV ejection fractiongreater than 0.40). (Level of Evidence: C)"

Class IIb

"1. PCImight be considered as part of an invasive strategy after fibrinolytic therapy. (Level of Evidence: C)"

PCI in patients with Prior Coronary Bypass Surgery

[77]

Class I
"1. When technically feasible, PCI should be performed in patients with early ischemia (usually within 30 days) after CABG. (Level of Evidence: B)"
"2. It is recommended that distal embolic protection devices be used when technically feasible in patients undergoing PCI to saphenous vein grafts. (Level of Evidence: B)"
Class III (No Benefit)
"1. PCI is not recommended in patients with prior CABG for chronic total vein graft occlusions.(Level of Evidence: B)"
"2. PCI is not recommended in patients who have multiple target lesions with prior CABG and who have multi-vessel disease,failure of multiple SVGs, andimpaired LV function unless repeat CABG poses excessive risk due to severe comorbid conditions. (Level of Evidence: B)"
Class IIa
"1. PCI is reasonable in patients with ischemia that occurs 1 to 3 years after CABG and who have preserved LV function with discrete lesions in graft conduits. (Level of Evidence: B)"
"2. PCI is reasonable in patients with disabling angina secondary to new disease in a native coronary circulation after CABG. (If angina is not typical, objective evidence ofischemia should be obtained.) (Level of Evidence: B)"
"3. PCI is reasonable in patients with diseased vein grafts more than 3 years afterCABG. (Level of Evidence: B)"
"4. PCI is reasonable when technically feasible in patients with a patent left internal mammary artery graft who have clinically significant obstructions in other vessels. (Level of Evidence: C)"
Revascularization Before Non-cardiac Surgery

[1]

Class III (No Benefit)
"1. Routine prophylactic coronary revascularizationshould not be performed in patients with stable CAD before noncardiac surgery.[92][93] (Level of Evidence: B)"
"2. Elective non-cardiac surgery should not be performed in the 4 to 6 weeks after balloon angioplasty or BMS implantation or the 12 months after DES implantation in patients in whom the P2Y12 inhibitorwill need to be discontinued peri-operatively.[94][95][96][97](Level of Evidence: B)"
Class IIa
"1. 1. For patients who require PCI and are scheduled for elective non-cardiac surgery in the subsequent 12 months, a strategy of balloon angioplasty, or BMS implantation followed by 4 to 6 weeks of dual antiplatelet therapy (DAPT), is reasonable.[98][99][100][96][101][95][102](Level of Evidence: B)"
"2. For patients with drug eluting stent (DES) who must undergo urgent surgical procedures that mandate the discontinuation of dual antiplatelet therapy (DAPT), it is reasonable to continue aspirin if possible and restart the P2Y12 inhibitor as soon as possible in the immediate postoperative period.[100][103] (Level of Evidence: C)"

2011 ACCF/AHA/SCAI Guideline Recommendations: Adjunctive Therapeutic Devices [1]

Thrombectomy

[1]

Class IIa
"1. Aspiration thrombectomy is reasonable for patients undergoing primary PCI.[104][105][106] (Level of Evidence: B)"

Laser Angioplasty

[1]

Class III (No Benefit)
"1. Laser angioplasty should not be used routinely during PCI. [107][108][109] (Level of Evidence: A)"
Class IIb
"1. Laser angioplasty might be considered for fibrotic or moderately calcified lesions that cannot be crossed or dilated with conventional balloon angioplasty. [110] (Level of Evidence: C)"

Intravenous Antiplatelet Therapy: Sudden Ischemia Heart Disease (SIHD)

[1]

Class IIa
"1. In patients undergoing elective PCI treated with unfractionated heparin (UFH) and not pretreated with clopidogrel, it is reasonable to administer aGP IIb/IIIa inhibitor (abciximab,double-bolus eptifibatide, or high-bolus dose tirofiban).[111][112][113] (Level of Evidence: B)"
Class IIb
"1. In patients undergoing elective PCI with stent implantation treated with unfractionated heparin (UFH) and adequately pretreated with clopidogrel, it might be reasonable to administer a GP IIb/IIIa inhibitor (abciximab, double-bolus eptifibatide, orhigh-bolus dose tirofiban).[111][114][115][116] (Level of Evidence: B)"

2011 ACCF/AHA/SCAI Guideline Recommendations: Peri-procedural Myocardial Infarction Assessment[1]

Peri-procedural Myocardial Infarction Assessment

Class I
"1. In patients who have signs orsymptoms suggestive of myocardial infarctionduring or after PCI or in asymptomatic patients with significant persistent angiographic complications (e.g., large side-branch occlusion, flow-limiting dissection, no reflow phenomenon, or coronary thrombosis), creatinine kinase-MB and troponin I or T should be measured. (Level of Evidence: C)"
Class IIb
"1. Routine measurement of cardiac biomarkers (creatinine kinase-MB and/or troponin I or T). (Level of Evidence: C)"

2011 ACCF/AHA/SCAI Guideline Recommendations: Restenosis [1]

Exercise Testing

[1]

Class III (No Benefit)
"1. Routine periodic stress testing of asymptomatic patients after PCI without specific clinical indications should not be performed.[117](Level of Evidence: C)"
Class IIa
"1. In patients entering a formal cardiac rehabilitation program after PCI, treadmill exercise testing is reasonable. (Level of Evidence: C)"

Cardiac Rehabilitation

[1]

Class I
"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.[118][119][120][121][122][123][124][125][126] (Level of Evidence: A)"

2011 ACCF/AHA/SCAI Guideline Recommendations: Quality and Performance Considerations [1]

Quality and Performance

[1]

Class I
"1. Every PCI program should operate a quality-improvement program that routinely
i. reviews quality and outcomes of the entire program; (Level of Evidence: C)
ii. reviews results of individual operators; (Level of Evidence: C)
iii. includes risk adjustment; (Level of Evidence: C)
iv. provides peer review of difficult or complicated cases; and (Level of Evidence: C)
v. performs random case reviews. (Level of Evidence: C)"
"2. Every PCI program should participate in a regional or national PCI registry for the purpose of benchmarking its outcomes against current national norms. (Level of Evidence: C)"

Certification and Maintenance of Certification

[1]

Class IIa
"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. (Level of Evidence: C)"

Operator and Institutional Competency and Volume

[1]

Class I
"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.[127][128] (Level of Evidence: C)"
"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. (Level of Evidence: C)"
"3. Primary PCI for STEMI should be performed by experienced operators who perform more than 75 elective PCI procedures per year and, ideally, at least 11 PCI procedures for STEMI per year. Ideally, these procedures should be performed in institutions that perform more than 400 elective PCIs per year and more than 36 Primary PCI procedures forSTEMI per year.[127][129][130][131][132] (Level of Evidence: C)"
Class III (No Benefit)
"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.[127] (Level of Evidence: C)"
Class IIa
"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-sitecardiac surgery.[127] (Level of Evidence: C)"
"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. (Level of Evidence: C)"
Class IIa
"1. The benefit of primary PCI for STEMI patients eligible for fibrinolysis when performed by an operator who performs fewer than 75 procedures per year (11 PCIs for STEMI per year) is not well established. (Level of Evidence: C)"

Guideline Resources

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 2.2 Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011)Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization. Am J Cardiol 107 (3):360-6. DOI:10.1016/j.amjcard.2010.09.029 PMID:21256999
  3. ↑ 3.0 3.1 3.2 Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) 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.DOI:10.1016/j.jcin.2010.04.004 PMID:20630454
  4. ↑ 4.0 4.1 4.2 4.3 Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010)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.DOI:10.1161/CIRCULATIONAHA.109.899211 PMID:20530001
  5. ↑ Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H et al. (1995) 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: 7729018
  6. ↑ Chaitman BR, Fisher LD, Bourassa MG, Davis K, Rogers WJ, Maynard C et al. (1981)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:7025604
  7. ↑ 7.0 7.1 Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD et al. (2001)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 J142 (1):119-26. DOI:10.1067/mhj.2001.116072 PMID:11431667
  8. ↑ Takaro T, Hultgren HN, Lipton MJ, Detre KM (1976) 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: 791537
  9. ↑ Takaro T, Peduzzi P, Detre KM, Hultgren HN, Murphy ML, van der Bel-Kahn J et al. (1982) 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: [1]
  10. ↑ Taylor HA, Deumite NJ, Chaitman BR, Davis KB, Killip T, Rogers WJ (1989) Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry. Circulation 79 (6):1171-9. PMID:2785870
  11. ↑ 11.0 11.1 Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW et al. (1994) Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 344 (8922):563-70. PMID: [2]
  12. ↑ 12.0 12.1 12.2 12.3 Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E et al. (2011)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. [3] PMID: 21697170
  13. ↑ 13.0 13.1 Capodanno D, Caggegi A, Miano M, Cincotta G, Dipasqua F, Giacchi G et al. (2011)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. DOI:10.1016/j.jcin.2010.10.013PMID: 21435606
  14. ↑ 14.0 14.1 14.2 14.3 Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR et al. (2008)Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med 358 (4):331-41.DOI:10.1056/NEJMoa071804 PMID: [4]
  15. ↑ 15.0 15.1 15.2 Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR et al. (1997) Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.Circulation 96 (11):3867-72. PMID: 9403609
  16. ↑ 16.0 16.1 Biondi-Zoccai GG, Lotrionte M, Moretti C, Meliga E, Agostoni P, Valgimigli M et al. (2008) 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.DOI:10.1016/j.ahj.2007.10.009 PMID:18215597
  17. ↑ 17.0 17.1 Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T et al. (2011)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.DOI:10.1016/j.jacc.2010.09.038 PMID:21272743
  18. ↑ 18.0 18.1 18.2 Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008) Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients. Am J Cardiol 101 (2):169-72. [5] PMID: 18178401
  19. ↑ 19.0 19.1 Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M et al. (2008) Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol 51 (5):538-45.DOI:10.1016/j.jacc.2007.09.054 PMID:18237682
  20. ↑ 20.0 20.1 20.2 Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M et al. (2006)Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.Circulation 113 (21):2542-7. [6] PMID: 16717151
  21. ↑ 21.0 21.1 21.2 Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. (2006)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. [7] PMID: 16487857
  22. ↑ 22.0 22.1 Mäkikallio TH, Niemelä M, Kervinen K, Jokinen V, Laukkanen J, Ylitalo I et al. (2008) 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. DOI:10.1080/07853890701879790PMID: 18608116
  23. ↑ 23.0 23.1 Naik H, White AJ, Chakravarty T, Forrester J, Fontana G, Kar S et al. (2009)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. [8] PMID: 19695542
  24. ↑ 24.0 24.1 Palmerini T, Marzocchi A, Marrozzini C, Ortolani P, Saia F, Savini C et al. (2006) 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.DOI:10.1016/j.amjcard.2006.01.070 PMID:16784920
  25. ↑ 25.0 25.1 Park DW, Seung KB, Kim YH, Lee JY, Kim WJ, Kang SJ et al. (2010) 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. [9] PMID: 20451344
  26. ↑ 26.0 26.1 26.2 Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E et al. (2008) 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.DOI:10.1161/CIRCULATIONAHA.107.727099 PMID:19029471
  27. ↑ 27.0 27.1 27.2 Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G et al. (2007) Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease. Am J Cardiol 100 (6):970-3.DOI:10.1016/j.amjcard.2007.04.037 PMID:17826380
  28. ↑ 28.0 28.1 28.2 Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al. (2008) Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med 358 (17):1781-92.DOI:10.1056/NEJMoa0801441 PMID:18378517
  29. ↑ 29.0 29.1 29.2 White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC et al. (2008)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. [10] PMID: 19463306
  30. ↑ Chieffo A, Magni V, Latib A, Maisano F, Ielasi A, Montorfano M et al. (2010)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. DOI:10.1016/j.jcin.2010.03.014 PMID:20630452
  31. ↑ Montalescot G, Brieger D, Eagle KA, Anderson FA, FitzGerald G, Lee MS et al. (2009) Unprotected left main revascularization in patients with acute coronary syndromes. Eur Heart J 30 (19):2308-17.DOI:10.1093/eurheartj/ehp353 PMID:19720640
  32. ↑ Lee MS, Tseng CH, Barker CM, Menon V, Steckman D, Shemin R et al. (2008)Outcome after surgery and percutaneous intervention for cardiogenic shock and left main disease. Ann Thorac Surg 86 (1):29-34.DOI:10.1016/j.athoracsur.2008.03.019 PMID:18573394
  33. ↑ Lee MS, Bokhoor P, Park SJ, Kim YH, Stone GW, Sheiban I et al. (2010) 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.DOI:10.1016/j.jcin.2010.06.005 PMID:20723848
  34. ↑ Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG et al. (2011)Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med 364 (18):1718-27.DOI:10.1056/NEJMoa1100452 PMID:[11]
  35. ↑ 35.0 35.1 Borger van der Burg AE, Bax JJ, Boersma E, Bootsma M, van Erven L, van der Wall EE, Schalij MJ (2003). "Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital". The American Journal of Cardiology. 91 (7): 785–9. PMID 12667561. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  36. ↑ Every NR, Fahrenbruch CE, Hallstrom AP, Weaver WD, Cobb LA (1992). "Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest". Journal of the American College of Cardiology. 19 (7): 1435–9. PMID 1593036. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  37. ↑ Kaiser GA, Ghahramani A, Bolooki H, Vargas A, Thurer RJ, Williams WH, Myerburg RJ (1975). "Role of coronary artery surgery in patients surviving unexpected cardiac arrest". Surgery. 78 (6): 749–54. PMID 1081278. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  38. ↑ 38.0 38.1 Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM (1996). "Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease". The Journal of Thoracic and Cardiovascular Surgery. 111 (5): 1013–25. PMID 8622299. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  39. ↑ Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, Fromm B (1998). "Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions". The Journal of Thoracic and Cardiovascular Surgery. 116 (6): 997–1004. PMID 9832692. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  40. ↑ Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003). "Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography". Circulation. 107 (23): 2900–7. doi:10.1161/01.CIR.0000072790.23090.41. PMID 12771008. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  41. ↑ Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, Weintraub WS, O'Rourke RA, Dada M, Spertus JA, Chaitman BR, Friedman J, Slomka P, Heller GV, Germano G, Gosselin G, Berger P, Kostuk WJ, Schwartz RG, Knudtson M, Veledar E, Bates ER, McCallister B, Teo KK, Boden WE (2008). "Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy". Circulation. 117 (10): 1283–91. doi:10.1161/CIRCULATIONAHA.107.743963. PMID 18268144. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  42. ↑ Cashin WL, Sanmarco ME, Nessim SA, Blankenhorn DH (1984). "Accelerated progression of atherosclerosis in coronary vessels with minimal lesions that are bypassed". The New England Journal of Medicine. 311 (13): 824–8. doi:10.1056/NEJM198409273111304. PMID 6332274. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  43. ↑ Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, Koolen JJ (1996). "Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses". The New England Journal of Medicine. 334 (26): 1703–8. doi:10.1056/NEJM199606273342604. PMID 8637515. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  44. ↑ Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF (2009). "Fractional flow reserve versus angiography for guiding percutaneous coronary intervention". The New England Journal of Medicine. 360 (3): 213–24. doi:10.1056/NEJMoa0807611. PMID 19144937. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  45. ↑ Sawada S, Bapat A, Vaz D, Weksler J, Fineberg N, Greene A, Gradus-Pizlo I, Feigenbaum H (2003). "Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction". Journal of the American College of Cardiology. 42 (12): 2099–105. PMID 14680734. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  46. ↑ 46.0 46.1 Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH (2006). "Selection of surgical or percutaneous coronary intervention provides differential longevity benefit". The Annals of Thoracic Surgery. 82 (4): 1420–8, discussion 1428–9. doi:10.1016/j.athoracsur.2006.04.044. PMID 16996946. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  47. ↑ 47.0 47.1 Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS (2004). "Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features". Circulation. 109 (19): 2290–5. doi:10.1161/01.CIR.0000126826.58526.14. PMID 15117846. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  48. ↑ 48.0 48.1 48.2 Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA (2005). "Long-term outcomes of coronary-artery bypass grafting versus stent implantation". The New England Journal of Medicine. 352 (21): 2174–83. doi:10.1056/NEJMoa040316. PMID 15917382. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  49. ↑ Sorajja P, Chareonthaitawee P, Rajagopalan N, Miller TD, Frye RL, Hodge DO, Gibbons RJ (2005). "Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting". Circulation. 112 (9 Suppl): I311–6. doi:10.1161/CIRCULATIONAHA.104.525022. PMID 16159837. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  50. ↑ "Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI)". Circulation. 96 (6): 1761–9. 1997. PMID 9323059. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  51. ↑ "The final 10-year follow-up results from the BARI randomized trial". Journal of the American College of Cardiology. 49 (15): 1600–6. 2007. doi:10.1016/j.jacc.2006.11.048. PMID 17433949. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  52. ↑ Banning AP, Westaby S, Morice MC, Kappetein AP, Mohr FW, Berti S, Glauber M, Kellett MA, Kramer RS, Leadley K, Dawkins KD, Serruys PW (2010). "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 of the American College of Cardiology. 55 (11): 1067–75. doi:10.1016/j.jacc.2009.09.057. PMID 20079596. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  53. ↑ Hueb W, Lopes NH, Gersh BJ, Soares P, Machado LA, Jatene FB, Oliveira SA, Ramires JA (2007). "Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease". Circulation. 115 (9): 1082–9. doi:10.1161/CIRCULATIONAHA.106.625475. PMID 17339566. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  54. ↑ 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 (2005). "Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England". Circulation. 112 (9 Suppl): I371–6. doi:10.1161/CIRCULATIONAHA.104.526392. PMID 16159849. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  55. ↑ 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 (2001). "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 of the American College of Cardiology. 37 (4): 1008–15. PMID 11263600. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  56. ↑ Weintraub WS, Stein B, Kosinski A, Douglas JS, Ghazzal ZM, Jones EL, Morris DC, Guyton RA, Craver JM, King SB (1998). "Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease". Journal of the American College of Cardiology. 31 (1): 10–9. PMID 9426011. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  57. ↑ 57.0 57.1 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 (2007). "Optimal medical therapy with or without PCI for stable coronary disease". The New England Journal of Medicine. 356 (15): 1503–16. doi:10.1056/NEJMoa070829. PMID 17387127. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  58. ↑ Brener SJ, Lytle BW, Casserly IP, Ellis SG, Topol EJ, Lauer MS (2006). "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". European Heart Journal. 27 (4): 413–8. doi:10.1093/eurheartj/ehi646. PMID 16272211. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  59. ↑ 59.0 59.1 Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA (2007). "Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery". International Journal of Cardiology. 119 (1): 65–72. doi:10.1016/j.ijcard.2006.07.058. PMID 17045681. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  60. ↑ Lytle BW, Loop FD, Taylor PC, Goormastic M, Stewart RW, Novoa R, McCarthy P, Cosgrove DM (1993). "The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries". The Journal of Thoracic and Cardiovascular Surgery. 105 (4): 605–12, discussion 612–4. PMID 8468995. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  61. ↑ 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 (2001). "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 of the American College of Cardiology. 38 (1): 143–9. PMID 11451264. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
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  125. ↑ 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 (2007). "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 of the American College of Cardiology. 50 (14): 1400–33. doi:10.1016/j.jacc.2007.04.033. PMID 17903645. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  126. ↑ Walther C, Möbius-Winkler S, Linke A, Bruegel M, Thiery J, Schuler G, Halbrecht R (2008). "Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease". 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. 15 (1): 107–12. doi:10.1097/HJR.0b013e3282f29aa6. PMID 18277195. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  127. ↑ 127.0 127.1 127.2 127.3 Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH (2005). "Volume-outcome relationships for percutaneous coronary interventions in the stent era". Circulation. 112 (8): 1171–9. doi:10.1161/CIRCULATIONAHA.104.528455. PMID 16103238. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  128. ↑ Post PN, Kuijpers M, Ebels T, Zijlstra F (2010). "The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis". European Heart Journal. 31 (16): 1985–92. doi:10.1093/eurheartj/ehq151. PMID 20511324. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  129. ↑ Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, Gore JM, Weaver WD, Rogers WJ, Tiefenbrunn AJ (2000). "Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction". JAMA :the Journal of the American Medical Association. 283 (22): 2941–7. PMID 10865271. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  130. ↑ Canto JG, Every NR, Magid DJ, Rogers WJ, Malmgren JA, Frederick PD, French WJ, Tiefenbrunn AJ, Misra VK, Kiefe CI, Barron HV (2000). "The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators". The New England Journal of Medicine. 342 (21): 1573–80. doi:10.1056/NEJM200005253422106. PMID 10824077. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  131. ↑ Srinivas VS, Hailpern SM, Koss E, Monrad ES, Alderman MH (2009). "Effect of physician volume on the relationship between hospital volume and mortality during primary angioplasty". Journal of the American College of Cardiology. 53 (7): 574–9. doi:10.1016/j.jacc.2008.09.056. PMID 19215830. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  132. ↑ Vakili BA, Kaplan R, Brown DL (2001). "Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in New York state". Circulation. 104 (18): 2171–6. PMID 11684626. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  133. ↑ Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. 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 of the American College of Cardiology. 58 (24): e44–122. doi:10.1016/j.jacc.2011.08.007. PMID 22070834. Retrieved 2012-03-16. Unknown parameter |month= ignored (help)


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