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| {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Lakshmi Gopalakrishnan, M.B.B.S.]] | | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Lakshmi Gopalakrishnan, M.B.B.S.]] |
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| ==Indications== | | ==2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) (DO NOT EDIT)<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>== |
| ===ACCF/AHA 2011 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> (DO NOT EDIT)===
| | ===Asymptomatic Ischemia or CCS Class I or II Angina (DO NOT EDIT)<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>=== |
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| =====Patients With Asymptomatic Ischemia or CCS Class I or II Angina<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>===== | |
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| |bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is not recommended in patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] who do not meet the criteria as listed under the class II recommendations or who have 1 or more of the following: | | |bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is not recommended in patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] who do not meet the criteria as listed under the class II recommendations or who have 1 or more of the following: |
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| :'''a.''' Only a small area of viable myocardium at risk, ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | | :'''a.''' Only a small area of viable myocardium at risk. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' |
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| :'''b.''' No objective evidence of [[ischemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | | :'''b.''' No objective evidence of [[ischemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' |
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| <nowiki>"</nowiki>'''3.''' Use of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]]is reasonable in patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] with significant [[left main]] [[CAD]] (greater than 50% diameter [[stenosis]]) who are candidates for [[Chronic stable angina revascularization|revascularization]] but are not eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | <nowiki>"</nowiki>'''3.''' Use of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable in patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] with significant [[left main]] [[CAD]] (greater than 50% diameter[[stenosis]]) who are candidates for [[Chronic stable angina revascularization|revascularization]] but are not eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> |
| |} | | |} |
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| <nowiki>"</nowiki>'''1.''' The effectiveness of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] for patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] who have 2- or 3-vessel disease with significant[[LAD|proximal LAD]] [[CAD]] who are otherwise eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] with 1 arterial conduit and who have treated [[diabetes]] or [[left ventricular dysfunction|abnormal LV function]] is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | <nowiki>"</nowiki>'''1.''' The effectiveness of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] for patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] who have 2- or 3-vessel disease with significant[[LAD|proximal LAD]] [[CAD]] who are otherwise eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]with 1 arterial conduit and who have treated [[diabetes]] or [[left ventricular dysfunction|abnormal LV function]] is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> |
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| =====Patients With CCS Class III Angina<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>===== | | ===CCS Class III Angina (DO NOT EDIT)<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>=== |
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| :'''b.''' All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | | :'''b.''' All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' |
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| :'''c.''' Ahigh risk of procedure-related morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | | :'''c.''' A high risk of procedure-related morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' |
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| :'''d.''' Insignificant disease (less than 50% coronary stenosis). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | | :'''d.''' Insignificant disease (less than 50% coronary stenosis). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' |
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| <nowiki>"</nowiki>'''1.''' It is reasonable that [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] be performed in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] and single-vessel or multi-vessel [[CAD]] who are undergoing[[Chronic stable angina pharmacotherapy overview|medical therapy]] and who have 1 or more significant lesions in 1 or more coronary arteries suitable for [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] with a high likelihood of success and low risk of morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | <nowiki>"</nowiki>'''1.''' It is reasonable that [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] be performed in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] and single-vessel or multi-vessel [[CAD]] who are undergoing [[Chronic stable angina pharmacotherapy overview|medical therapy]] and who have 1 or more significant lesions in 1 or more coronary arteries suitable for [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] with a high likelihood of success and low risk of morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> |
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| <nowiki>"</nowiki>'''3.''' Use of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] with significant [[left main]] [[CAD]] (greater than 50% diameter stenosis) who are candidates for [[Chronic stable angina revascularization|revascularization]] but are not eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | <nowiki>"</nowiki>'''3.''' Use of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] with significant [[left main]] [[CAD]](greater than 50% diameter stenosis) who are candidates for [[Chronic stable angina revascularization|revascularization]] but are not eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> |
| |} | | |} |
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| <nowiki>"</nowiki>'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] may be considered in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] and no evidence of [[ischemia]] on noninvasive testing or who are undergoing[[Chronic stable angina pharmacotherapy overview|medical therapy]] and have 2- or 3-vessel [[CAD]]with significant [[LAD|proximal LAD]] [[CAD]] and treated [[diabetes]] or [[left ventricular dysfunction|abnormal LV function]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | <nowiki>"</nowiki>'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] may be considered in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] and no evidence of [[ischemia]] on noninvasive testing or who are undergoing [[Chronic stable angina pharmacotherapy overview|medical therapy]] and have 2- or 3-vessel [[CAD]] with significant [[LAD|proximal LAD]] [[CAD]] and treated [[diabetes]] or [[left ventricular dysfunction|abnormal LV function]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> |
| |}
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| =====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>=====
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| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| <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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| |colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
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| <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>
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| | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| <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>
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| <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>
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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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| <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>
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| <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>
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| *PCI has been shown to reduce the frequency of anginal symptoms and improve exercise tolerance in patients with [[CAD|single and double-vessel coronary artery disease]].<ref name="pmid1345754">Parisi AF, Folland ED, Hartigan P (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1345754 A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans Affairs ACME Investigators.] ''N Engl J Med'' 326 (1):10-6. [http://dx.doi.org/10.1056/NEJM199201023260102 DOI:10.1056/NEJM199201023260102] PMID: [http://pubmed.gov/1345754 1345754]</ref><ref name="pmid9874045">Hartigan PM, Giacomini JC, Folland ED, Parisi AF (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9874045 Two- to three-year follow-up of patients with single-vessel coronary artery disease randomized to PTCA or medical therapy (results of a VA cooperative study). Veterans Affairs Cooperative Studies Program ACME Investigators. Angioplasty Compared to Medicine.] ''Am J Cardiol'' 82 (12):1445-50. PMID: [http://pubmed.gov/9874045 9874045]</ref><ref name="pmid9180111">Folland ED, Hartigan PM, Parisi AF (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9180111 Percutaneous transluminal coronary angioplasty versus medical therapy for stable angina pectoris: outcomes for patients with double-vessel versus single-vessel coronary artery disease in a Veterans Affairs Cooperative randomized trial. Veterans Affairs ACME InvestigatorS.] ''J Am Coll Cardiol'' 29 (7):1505-11. PMID: [http://pubmed.gov/9180111 9180111]</ref>
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| *In patients with [[Ischemia|objective large ischemia]] associated with severe angina, PCI has shown to significantly reduce mortality and provide greater symptomatic improvement. However, on the contrary, patients with mild symptoms do not benefit from PCI.<ref name="pmid9274581"> (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9274581 Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. RITA-2 trial participants.] ''Lancet'' 350 (9076):461-8. PMID: [http://pubmed.gov/9274581 9274581]</ref><ref name="pmid10395630">Pitt B, Waters D, Brown WV, van Boven AJ, Schwartz L, Title LM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10395630 Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. Atorvastatin versus Revascularization Treatment Investigators.] ''N Engl J Med'' 341 (2):70-6. [http://dx.doi.org/10.1056/NEJM199907083410202 DOI:10.1056/NEJM199907083410202] PMID: [http://pubmed.gov/10395630 10395630]</ref><ref name="pmid10884254">Bucher HC, Hengstler P, Schindler C, Guyatt GH (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10884254 Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials.] ''BMJ'' 321 (7253):73-7. PMID: [http://pubmed.gov/10884254 10884254]</ref>
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| *Despite the high rates of [[restenosis]] associated with PCI, it may be beneficial for [[Occlusive coronary artery thrombus|chronic total occlusions]] only in cases where the distal lumen could be accessed and favorable results could be obtained with [[Stent|stent implantation]].
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| *In patients with [[ischemia|refractory ischemia]] and [[PCI in the patient with severely depressed ventricular function|severe LV dysfunction]] with [[EF|ejection fraction less than 35%]] may benefit from PCI in comparison to [[Chronic stable angina revascularization coronary artery bypass grafting(CABG)|CABG]].
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| *In patients with [[PCI in the unprotected left main patient|unprotected left main]] [[CAD|disease]] associated with high peri-operative risk for [[Chronic stable angina revascularization coronary artery bypass grafting(CABG)|CABG]], PCI with stent implantation may be considered as an revascularization option.<ref name="pmid12927190">Kelley MP, Klugherz BD, Hashemi SM, Meneveau NF, Johnston JM, Matthai WH et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12927190 One-year clinical outcomes of protected and unprotected left main coronary artery stenting.] ''Eur Heart J'' 24 (17):1554-9. PMID: [http://pubmed.gov/12927190 12927190]</ref><ref name="pmid12888147">Arampatzis CA, Lemos PA, Tanabe K, Hoye A, Degertekin M, Saia F et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12888147 Effectiveness of sirolimus-eluting stent for treatment of left main coronary artery disease.] ''Am J Cardiol'' 92 (3):327-9. PMID: [http://pubmed.gov/12888147 12888147]</ref><ref name="pmid15389236">de Lezo JS, Medina A, Pan M, Delgado A, Segura J, Pavlovic D et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15389236 Rapamycin-eluting stents for the treatment of unprotected left main coronary disease.] ''Am Heart J'' 148 (3):481-5. [http://dx.doi.org/10.1016/j.ahj.2004.03.011 DOI:10.1016/j.ahj.2004.03.011] PMID: [http://pubmed.gov/15389236 15389236]</ref>
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| ==Supportive Trial Data==
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| *The '''ACIP study''', a randomized study of 558 patients with increased cardiac events, compared the 12-week efficacy of three treatment strategies such as [[Chronic stable angina pharmacotherapy overview|medical therapy]], [[Chronic stable angina pharmacotherapy overview|medical therapy]] plus [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG monitoring]] or [[Chronic stable angina revascularization|revascularization]] to suppress [[ischemia|cardiac ischemia]]. The goal of the study was to assess the feasibility of a [[Chronic stable angina prognosis|prognosis]] trial in patients with asymptomatic cardiac ischemia, demonstrated both stress-inducible ischemia and two or more ischemic episodes on holter monitoring.<ref name="pmid8006249">Pepine CJ, Geller NL, Knatterud GL, Bourassa MG, Chaitman BR, Davies RF et al. (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8006249 The Asymptomatic Cardiac Ischemia Pilot (ACIP) study: design of a randomized clinical trial, baseline data and implications for a long-term outcome trial.] ''J Am Coll Cardiol'' 24 (1):1-10. PMID: [http://pubmed.gov/8006249 8006249]</ref> '''Two years after randomization''' (1997), the total mortality was significantly reduced from 6.6% in the angina-guided strategy to 4.4% in the ischemia-guided strategy and 1.1% in the revascularization strategy ''(p=less than 0.02)''. The rate of composite primary end-points was also significantly reduced from 41.8% in the angina-guided strategy to 38.5% in the ischemia-guided strategy and 23.1% in the revascularization strategy ''(p=less than 0.001)''. Researchers concluded that a strategy of initial revascularization appeared to improve the prognosis but longer-term study was needed to further establish this relationship. <ref name="pmid9133513">Davies RF, Goldberg AD, Forman S, Pepine CJ, Knatterud GL, Geller N et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9133513 Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: outcomes of patients randomized to initial strategies of medical therapy versus revascularization.] ''Circulation'' 95 (8):2037-43. PMID: [http://pubmed.gov/9133513 9133513]</ref><ref name="pmid9133513">Davies RF, Goldberg AD, Forman S, Pepine CJ, Knatterud GL, Geller N et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9133513 Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: outcomes of patients randomized to initial strategies of medical therapy versus revascularization.] ''Circulation'' 95 (8):2037-43. PMID: [http://pubmed.gov/9133513 9133513]</ref>
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| *The '''TIME study''' (2004) assessed the long-term survival and quality of life in 276 elderly patients with [[Canadian cardiovascular society classification of angina pectoris|CCS]] class II or greater angina receiving atleast two anti-anginal medication at baseline. The study demonstrated similar long-term survival benefits observed in both the groups; however, freedom from major cardiovascular events remained higher in invasive therapy group versus the medical therapy group ''(39% versus 20%, p=less than 0.0001)''. Irrespective of whether patients were catheterized initially or only after failure to respond to [[Chronic stable angina pharmacotherapy overview|medical therapy]], their survival rates were better if they were revascularized within the first year.<ref name="pmid15337691">Pfisterer M, Trial of Invasive versus Medical therapy in Elderly patients Investigators (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15337691 Long-term outcome in elderly patients with chronic angina managed invasively versus by optimized medical therapy: four-year follow-up of the randomized Trial of Invasive versus Medical therapy in Elderly patients (TIME).] ''Circulation'' 110 (10):1213-8. [http://dx.doi.org/10.1161/01.CIR.0000140983.69571.BA DOI:10.1161/01.CIR.0000140983.69571.BA] PMID: [http://pubmed.gov/15337691 15337691]</ref>
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| *The '''GISSOC trial''' (2003) studied the benefit of stent implantation over balloon PTCA for the treatment of chronic total coronary occlusions in six-year clinical follow-up patients. The study demonstrated a significant reduction in the major adverse cardiovascular events observed in the stent group during a 6-year follow-up ''(76.1% in the stent group versus 60.4% in the PTCA group; p=0.055)'' and attributed this reduction secondary to the target lesion revascularization free-survival rate ''(85.1% in the stent group versus 65.5% in the PTCA group; p=0.0165)''. However, in most cases, [[restenosis]] of the study occlusion was evident at nine-month angiography. Thus, the study concluded stent implantation was superior to balloon PTCA in chronic total occlusions that can be recanalized percutaneously and is a valuable long-term therapeutic option; however, at nine-month follow-up both the stent and PTCA results appear to remain stable.<ref name="pmid12742287">Rubartelli P, Verna E, Niccoli L, Giachero C, Zimarino M, Bernardi G et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12742287 Coronary stent implantation is superior to balloon angioplasty for chronic coronary occlusions: six-year clinical follow-up of the GISSOC trial.] ''J Am Coll Cardiol'' 41 (9):1488-92. PMID: [http://pubmed.gov/12742287 12742287]</ref>
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| *Similar benefits with stent implantation for chronic total occlusion were reported in few other studies such as:
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| :*The '''SICCO trial''' (1996) reported a significant reduction in the target lesion revascularization ''(22% in the stent group versus 42% in the PTCA group; p=0.025)'' and [[restenosis]] ''(32% patients with stent and 74% patients with PTCA only; p=0.025)'' noted in the stent implantation group.<ref name="pmid8917256">Sirnes PA, Golf S, Myreng Y, Mølstad P, Emanuelsson H, Albertsson P et al. (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8917256 Stenting in Chronic Coronary Occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty.] ''J Am Coll Cardiol'' 28 (6):1444-51. PMID: [http://pubmed.gov/8917256 8917256]</ref>
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| :*The '''TOSCA study''' (1999) demonstrated stent implantation significantly improved late patency and reduced the rates of [[restenosis]] ''(70% in the PTCA group versus 55% in the stent group; p=less than 0.01)'' and target-vessel revascularization ''(15.4% in the PTCA group versus 8.4% in the stent group; p=0.03)''. Hence, the study concluded stent implantation being superior to PTCA for non-acute coronary occlusions.<ref name="pmid10411846">Buller CE, Dzavik V, Carere RG, Mancini GB, Barbeau G, Lazzam C et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10411846 Primary stenting versus balloon angioplasty in occluded coronary arteries: the Total Occlusion Study of Canada (TOSCA).] ''Circulation'' 100 (3):236-42. PMID: [http://pubmed.gov/10411846 10411846]</ref>
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| :*The '''SARECCO trial''' (1999) demonstrated a significant event free survival in the stent group observed during a 2-year follow-up ''(26% in the group that received angioplasty alone versus 52% in the stent group; p=less than 0.05)''.<ref name="pmid10468073">Sievert H, Rohde S, Utech A, Schulze R, Scherer D, Merle H et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10468073 Stent or angioplasty after recanalization of chronic coronary occlusions? (The SARECCO Trial).] ''Am J Cardiol'' 84 (4):386-90. PMID: [http://pubmed.gov/10468073 10468073]</ref>
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| :*The '''SPACTO trial''' (1999) demonstrated significant reduction in the rates of [[restenosis]] ''(29% in the stent group versus 72% in the PTCA group; p=less than 0.01)'' and [[reocclusion]] ''(3% in the stent group versus 24% in the PTCA group)'' observed in the stent group. At follow-up,there was also a significant reduction in cardiac events ''(p=less than 0.03)'' and marked improvement in the anginal class ''(p=less than 0.01)'' reported in the stent group.<ref name="pmid10483953">Höher M, Wöhrle J, Grebe OC, Kochs M, Osterhues HH, Hombach V et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10483953 A randomized trial of elective stenting after balloon recanalization of chronic total occlusions.] ''J Am Coll Cardiol'' 34 (3):722-9. PMID: [http://pubmed.gov/10483953 10483953]</ref>
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| :*The '''STOP study''' (2000) demonstrated significant reduction in the rate of [[restenosis]] ''(42.1% in the stent group versus 70.9% in the PTCA group; p=0.034)'' and [[reocclusion]] ''(7.9% in the stent group versus 16.1% in the PTCA group)'' observed with the stent implantation. However, stent group was associated with more a diffuse in-stent restenosis in comparison to a focal re-stenosis in the PTCA group that occurred at the point of total obstruction (within 5mm).<ref name="pmid11071802">Lotan C, Rozenman Y, Hendler A, Turgeman Y, Ayzenberg O, Beyar R et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11071802 Stents in total occlusion for restenosis prevention. The multicentre randomized STOP study. The Israeli Working Group for Interventional Cardiology.] ''Eur Heart J'' 21 (23):1960-6. [http://dx.doi.org/10.1053/euhj.2000.2295 DOI:10.1053/euhj.2000.2295] PMID: [http://pubmed.gov/11071802 11071802]</ref>
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| :*The '''PRISON study''' (2004) demonstrated a statistically significant reduction in the need for target lesion revascularization ''(29% in the PTCA group versus 13% in the stent group; p=less than 0.0001)'' and a non-significant rate of [[restenosis]] was observed ''(33% in the PTCA group versus 22% in the stent group; p=0.137)''.<ref name="pmid15131557">Rahel BM, Suttorp MJ, Laarman GJ, Kiemeneij F, Bal ET, Rensing BJ et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15131557 Primary stenting of occluded native coronary arteries: final results of the Primary Stenting of Occluded Native Coronary Arteries (PRISON) study.] ''Am Heart J'' 147 (5):e22. [http://dx.doi.org/10.1016/j.ahj.2003.11.023 DOI:10.1016/j.ahj.2003.11.023] PMID: [http://pubmed.gov/15131557 15131557]</ref>
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| *In the '''PACTO study''' (2004), 48 consecutive patients received [[paclitaxel|paclitaxel-eluting stent]] implantation after successful recanalization of a chronic total occlusion, researchers assessed the efficacy of drug-eluting stent in comparison to bare metal stent for the treatment of chronic total coronary occlusions. At 1-year follow-up, the incidence of major adverse cardiovascular events was significantly reduced in the [[paclitaxel]] group ''(12.5% in the Taxus group and 47.9% in the BMS group; p=less than 0.001)'' which was secondary to reduced need for repeat revascularization. The secondary end-points included the rate of [[restenosis]] ''(8.3% in the Taxus group and 51.1% in the BMS group; p=less than 0.001)'' and [[reocclusion]] ''(2.1% in the Taxus group and 23.4% in the BMS group; p=less than 0.005)'' which was also significantly reduced in the paclitaxel group. Thus, the study concluded, paclitaxel-eluting stent drastically reduced the incidence of major cardiovascular events and [[restenosis]], and almost eliminated [[reocclusion]], frequently observed with bare metal stents when used for chronic total occlusion.<ref name="pmid15607390">Werner GS, Krack A, Schwarz G, Prochnau D, Betge S, Figulla HR (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15607390 Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents.] ''J Am Coll Cardiol'' 44 (12):2301-6. [http://dx.doi.org/10.1016/j.jacc.2004.09.040 DOI:10.1016/j.jacc.2004.09.040] PMID: [http://pubmed.gov/15607390 15607390]</ref>
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| *The '''AWESOME trial and registry''' (2004) demonstrated the benefit of PCI over CABG in patients with refractory ischemia and who are at increased risk of adverse events, which may also be applicable to patients with [[left ventricular dysfunction]].<ref name="pmid10588300">Morrison DA, Sethi G, Sacks J, Grover F, Sedlis S, Esposito R et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10588300 A multicenter, randomized trial of percutaneous coronary intervention versus bypass surgery in high-risk unstable angina patients. The AWESOME (Veterans Affairs Cooperative Study #385, angina with extremely serious operative mortality evaluation) investigators from the Cooperative Studies Program of the Department of Veterans Affairs.] ''Control Clin Trials'' 20 (6):601-19. PMID: [http://pubmed.gov/10588300 10588300]</ref><ref name="pmid15219521">Sedlis SP, Ramanathan KB, Morrison DA, Sethi G, Sacks J, Henderson W et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15219521 Outcome of percutaneous coronary intervention versus coronary bypass grafting for patients with low left ventricular ejection fractions, unstable angina pectoris, and risk factors for adverse outcomes with bypass (the AWESOME Randomized Trial and Registry).] ''Am J Cardiol'' 94 (1):118-20. [http://dx.doi.org/10.1016/j.amjcard.2004.03.041 DOI:10.1016/j.amjcard.2004.03.041] PMID: [http://pubmed.gov/15219521 15219521]</ref>
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| *In a '''sub-study''' (2002) of patients with prior [[Chronic stable angina revascularization coronary artery bypass grafting(CABG)|CABG]], the three-year survival rate between CABG and PCI groups did not differ significantly: 73% in the CABG group and 76% in the PCI group ''(p=NS)''. However, the '''patient choice registry''' reported that the patients with prior-CABG preferred PCI over repeat CABG.<ref name="pmid12475454">Morrison DA, Sethi G, Sacks J, Henderson WG, Grover F, Sedlis S et al. (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12475454 Percutaneous coronary intervention versus repeat bypass surgery for patients with medically refractory myocardial ischemia: AWESOME randomized trial and registry experience with post-CABG patients.] ''J Am Coll Cardiol'' 40 (11):1951-4. PMID: [http://pubmed.gov/12475454 12475454]</ref>
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| [[Category:Ischemic heart diseases]] | | [[Category:Ischemic heart diseases]] |