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===Cardiac Rehabilitation===
__NOTOC__
<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>
{{Percutaneous Coronary Intervention}}
{{CMG}}
 
==ACCF/AHA 2011 Guidelines for Percutaneous Coronary Intervention: Cardiac Rehabilitation<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref> (DO NOT EDIT)==


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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.<ref name="pmid21576654">{{cite journal |author=Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ |title=Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community |journal=[[Circulation]] |volume=123|issue=21 |pages=2344–52 |year=2011 |month=May |pmid=21576654 |doi=10.1161/CIRCULATIONAHA.110.983536|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21576654|accessdate=2011-12-16}}</ref><ref name="pmid15121495">{{cite journal |author=Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N|title=Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials |journal=[[The American Journal of Medicine]]|volume=116 |issue=10 |pages=682–92 |year=2004 |month=May |pmid=15121495|doi=10.1016/j.amjmed.2004.01.009 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002934304001238|accessdate=2011-12-16}}</ref><ref name="pmid19001195">{{cite journal |author=Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, Chieffo C, Gattone M, Griffo R, Schweiger C, Tavazzi L, Urbinati S, Valagussa F, Vanuzzo D |title=Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network|journal=[[Archives of Internal Medicine]] |volume=168 |issue=20 |pages=2194–204 |year=2008|month=November |pmid=19001195 |doi=10.1001/archinte.168.20.2194|url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=19001195|accessdate=2011-12-16}}</ref><ref name="pmid15337208">{{cite journal |author=Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL |title=Cardiac rehabilitation after myocardial infarction in the community |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=5 |pages=988–96 |year=2004 |month=September |pmid=15337208|doi=10.1016/j.jacc.2004.05.062|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01142-8|accessdate=2011-12-16}}</ref><ref name="pmid11581152">{{cite journal |author=Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T |title=Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association |journal=[[Circulation]]|volume=104 |issue=14 |pages=1694–740 |year=2001 |month=October |pmid=11581152 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11581152|accessdate=2011-12-16}}</ref><ref name="pmid12909570">{{cite journal |author=Thompson PD|title=Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease |journal=[[Arteriosclerosis, Thrombosis, and Vascular Biology]] |volume=23|issue=8 |pages=1319–21 |year=2003 |month=August |pmid=12909570|doi=10.1161/01.ATV.0000087143.33998.F2 |url=http://atvb.ahajournals.org/cgi/pmidlookup?view=long&pmid=12909570 |accessdate=2011-12-16}}</ref><ref name="pmid16263889">{{cite journal|author=Clark AM, Hartling L, Vandermeer B, McAlister FA |title=Meta-analysis: secondary prevention programs for patients with coronary artery disease |journal=[[Annals of Internal Medicine]]|volume=143 |issue=9 |pages=659–72 |year=2005 |month=November |pmid=16263889 |doi= |url=|accessdate=2011-12-16}}</ref><ref name="pmid17903645">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Bonow RO, Estes NA, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=50|issue=14 |pages=1400–33 |year=2007 |month=October |pmid=17903645 |doi=10.1016/j.jacc.2007.04.033|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)01339-3|accessdate=2011-12-16}}</ref><ref name="pmid18277195">{{cite journal |author=Walther C, Möbius-Winkler S, Linke A, Bruegel M, Thiery J, Schuler G, Halbrecht R |title=Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease |journal=[[European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology]] |volume=15 |issue=1 |pages=107–12 |year=2008 |month=February |pmid=18277195|doi=10.1097/HJR.0b013e3282f29aa6 |url=http://cpr.sagepub.com/cgi/pmidlookup?view=long&pmid=18277195|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.<ref name="pmid21576654">{{cite journal |author=Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ |title=Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community |journal=[[Circulation]] |volume=123|issue=21 |pages=2344–52 |year=2011 |month=May |pmid=21576654 |doi=10.1161/CIRCULATIONAHA.110.983536|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21576654|accessdate=2011-12-16}}</ref><ref name="pmid15121495">{{cite journal |author=Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N|title=Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials |journal=[[The American Journal of Medicine]]|volume=116 |issue=10 |pages=682–92 |year=2004 |month=May |pmid=15121495|doi=10.1016/j.amjmed.2004.01.009 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002934304001238|accessdate=2011-12-16}}</ref><ref name="pmid19001195">{{cite journal |author=Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, Chieffo C, Gattone M, Griffo R, Schweiger C, Tavazzi L, Urbinati S, Valagussa F, Vanuzzo D |title=Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network|journal=[[Archives of Internal Medicine]] |volume=168 |issue=20 |pages=2194–204 |year=2008|month=November |pmid=19001195 |doi=10.1001/archinte.168.20.2194|url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=19001195|accessdate=2011-12-16}}</ref><ref name="pmid15337208">{{cite journal |author=Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL |title=Cardiac rehabilitation after myocardial infarction in the community |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=5 |pages=988–96 |year=2004 |month=September |pmid=15337208|doi=10.1016/j.jacc.2004.05.062|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01142-8|accessdate=2011-12-16}}</ref><ref name="pmid11581152">{{cite journal |author=Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T |title=Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association |journal=[[Circulation]]|volume=104 |issue=14 |pages=1694–740 |year=2001 |month=October |pmid=11581152 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11581152|accessdate=2011-12-16}}</ref><ref name="pmid12909570">{{cite journal |author=Thompson PD|title=Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease |journal=[[Arteriosclerosis, Thrombosis, and Vascular Biology]] |volume=23|issue=8 |pages=1319–21 |year=2003 |month=August |pmid=12909570|doi=10.1161/01.ATV.0000087143.33998.F2 |url=http://atvb.ahajournals.org/cgi/pmidlookup?view=long&pmid=12909570 |accessdate=2011-12-16}}</ref><ref name="pmid16263889">{{cite journal|author=Clark AM, Hartling L, Vandermeer B, McAlister FA |title=Meta-analysis: secondary prevention programs for patients with coronary artery disease |journal=[[Annals of Internal Medicine]]|volume=143 |issue=9 |pages=659–72 |year=2005 |month=November |pmid=16263889 |doi= |url=|accessdate=2011-12-16}}</ref><ref name="pmid17903645">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Bonow RO, Estes NA, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=50|issue=14 |pages=1400–33 |year=2007 |month=October |pmid=17903645 |doi=10.1016/j.jacc.2007.04.033|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)01339-3|accessdate=2011-12-16}}</ref><ref name="pmid18277195">{{cite journal |author=Walther C, Möbius-Winkler S, Linke A, Bruegel M, Thiery J, Schuler G, Halbrecht R |title=Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease |journal=[[European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology]] |volume=15 |issue=1 |pages=107–12 |year=2008 |month=February |pmid=18277195|doi=10.1097/HJR.0b013e3282f29aa6 |url=http://cpr.sagepub.com/cgi/pmidlookup?view=long&pmid=18277195|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
|}
==References==
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]


==2011 ACCF/AHA/SCAI Guideline Recommendations: Quality and Performance Considerations <ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
==2011 ACCF/AHA/SCAI Guideline Recommendations: Quality and Performance Considerations <ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==

Revision as of 22:58, 18 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

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

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

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) [2][3][4]; PCI (Level of Evidence: C) [2])"

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. [5][6][7][8][9][10][11][12][13](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. [14][15][16][17][18] (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. [19][20][21][22][18][23][24][25][26] (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. [27][6][14][28] (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. [29][30][31][32][33][34][35][36][37] (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. [28][38][39][40][41][42][43][44][45][46][47] (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. [30][33][36] (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. [16][17][15][18](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. [37] (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]

PCI After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion[48]
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

[48]

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.[49][50] (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.[51][52][53][54](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.[55][56][57][53][58][52][59](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.[57][60] (Level of Evidence: C)"

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

Laser Angioplasty

[1]

Class III (No Benefit)
"1. Laser angioplasty should not be used routinely during PCI. [61][62][63] (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. [64] (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.[65](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)"


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: basic principles and guidelines On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]

ACCF/AHA 2011 Guidelines for Percutaneous Coronary Intervention: Cardiac Rehabilitation[1] (DO NOT EDIT)

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.[66][67][68][69][70][71][72][73][74] (Level of Evidence: A)"

References

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  2. ↑ 2.0 2.1 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)
  3. ↑ 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)
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  5. ↑ Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R (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 7914958. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
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  12. ↑ 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)
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  14. ↑ 14.0 14.1 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)
  15. ↑ 15.0 15.1 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)
  16. ↑ 16.0 16.1 Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH (2008). "Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease". The New England Journal of Medicine. 358 (4): 331–41. doi:10.1056/NEJMoa071804. PMID 18216353. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  17. ↑ 17.0 17.1 Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A (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". European Heart Journal. 32 (17): 2125–34. doi:10.1093/eurheartj/ehr213. PMID 21697170. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  18. ↑ 18.0 18.1 18.2 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)
  19. ↑ 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)
  20. ↑ "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)
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  23. ↑ 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)
  24. ↑ 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)
  25. ↑ 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)
  26. ↑ 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)
  27. ↑ Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD, Galbraith PD, Hui W, Faris P, Knudtson ML (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". American Heart Journal. 142 (1): 119–26. doi:10.1067/mhj.2001.116072. PMID 11431667. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
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  29. ↑ 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)
  30. ↑ 30.0 30.1 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)
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  34. ↑ Sergeant P, Blackstone E, Meyns B, Stockman B, Jashari R (1998). "First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 14 (5): 480–7. PMID 9860204. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  35. ↑ Stephan WJ, O'Keefe JH, Piehler JM, McCallister BD, Dahiya RS, Shimshak TM, Ligon RW, Hartzler GO (1996). "Coronary angioplasty versus repeat coronary artery bypass grafting for patients with previous bypass surgery". Journal of the American College of Cardiology. 28 (5): 1140–6. doi:10.1016/S0735-1097(96)00286-0. PMID 8890807. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  36. ↑ 36.0 36.1 Subramanian S, Sabik JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW (2009). "Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending". The Annals of Thoracic Surgery. 87 (5): 1392–8, discussion 1400. doi:10.1016/j.athoracsur.2009.02.032. PMID 19379872. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  37. ↑ 37.0 37.1 Weintraub WS, Jones EL, Morris DC, King SB, Guyton RA, Craver JM (1997). "Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery". Circulation. 95 (4): 868–77. PMID 9054744. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  38. ↑ "Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial". Lancet. 358 (9286): 951–7. 2001. doi:10.1016/S0140-6736(01)06100-1. PMID 11583747. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  39. ↑ Benzer W, Höfer S, Oldridge NB (2003). "Health-related quality of life in patients with coronary artery disease after different treatments for angina in routine clinical practice". Herz. 28 (5): 421–8. doi:10.1007/s00059-003-2388-9. PMID 12928741. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  40. ↑ Bonaros N, Schachner T, Ohlinger A, Friedrich G, Laufer G, Bonatti J (2005). "Assessment of health-related quality of life after coronary revascularization". The Heart Surgery Forum. 8 (5): E380–5. doi:10.1532/HSF98.20051139. PMID 16174598. Retrieved 2011-12-06.
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  42. ↑ Favarato ME, Hueb W, Boden WE, Lopes N, Nogueira CR, Takiuti M, Góis AF, Borges JC, Favarato D, Aldrighi JM, Oliveira SA, Ramires JA (2007). "Quality of life in patients with symptomatic multivessel coronary artery disease: a comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS II trial". International Journal of Cardiology. 116 (3): 364–70. doi:10.1016/j.ijcard.2006.06.001. PMID 16876891. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  43. ↑ Hueb W, Lopes N, Gersh BJ, Soares PR, Ribeiro EE, Pereira AC, Favarato D, Rocha AS, Hueb AC, Ramires JA (2010). "Ten-year follow-up survival of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease". Circulation. 122 (10): 949–57. doi:10.1161/CIRCULATIONAHA.109.911669. PMID 20733102. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  44. ↑ Pocock SJ, Henderson RA, Seed P, Treasure T, Hampton JR (1996). "Quality of life, employment status, and anginal symptoms after coronary angioplasty or bypass surgery. 3-year follow-up in the Randomized Intervention Treatment of Angina (RITA) Trial". Circulation. 94 (2): 135–42. PMID 8674171. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  45. ↑ Pocock SJ, Henderson RA, Clayton T, Lyman GH, Chamberlain DA (2000). "Quality of life after coronary angioplasty or continued medical treatment for angina: three-year follow-up in the RITA-2 trial. Randomized Intervention Treatment of Angina". Journal of the American College of Cardiology. 35 (4): 907–14. PMID 10732887. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  46. ↑ Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, Zhang W, Hartigan PM, Lewis C, Veledar E, Bowen J, Dunbar SB, Deaton C, Kaufman S, O'Rourke RA, Goeree R, Barnett PG, Teo KK, Boden WE, Mancini GB (2008). "Effect of PCI on quality of life in patients with stable coronary disease". The New England Journal of Medicine. 359 (7): 677–87. doi:10.1056/NEJMoa072771. PMID 18703470. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  47. ↑ Wijeysundera HC, Nallamothu BK, Krumholz HM, Tu JV, Ko DT (2010). "Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief". Annals of Internal Medicine. 152 (6): 370–9. doi:10.1059/0003-4819-152-6-201003160-00007. PMID 20231568. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  48. ↑ 48.0 48.1 Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO (2009). "2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Journal of the American College of Cardiology. 54 (23): 2205–41. doi:10.1016/j.jacc.2009.10.015. PMID 19942100. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  49. ↑ Cinà CS, Devereaux PJ (2006). "Coronary-artery revascularization before elective major vascular surgery. McFalls EO, ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. N Engl J Med. 2004; 351: 2795-804". Vascular Medicine (London, England). 11 (1): 61–3. PMID 16669417. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  50. ↑ Schouten O, van Kuijk JP, Flu WJ, Winkel TA, Welten GM, Boersma E, Verhagen HJ, Bax JJ, Poldermans D (2009). "Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study)". The American Journal of Cardiology. 103 (7): 897–901. doi:10.1016/j.amjcard.2008.12.018. PMID 19327412. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  51. ↑ Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P (2007). "Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians". Journal of the American College of Cardiology. 49 (6): 734–9. doi:10.1016/j.jacc.2007.01.003. PMID 17291948. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  52. ↑ 52.0 52.1 Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, Lindsay J (2004). "Major noncardiac surgery following coronary stenting: when is it safe to operate?". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 63 (2): 141–5. doi:10.1002/ccd.20124. PMID 15390248. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  53. ↑ 53.0 53.1 Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE (2000). "Catastrophic outcomes of noncardiac surgery soon after coronary stenting". Journal of the American College of Cardiology. 35 (5): 1288–94. PMID 10758971. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  54. ↑ Win HK, Caldera AE, Maresh K, Lopez J, Rihal CS, Parikh MA, Granada JF, Marulkar S, Nassif D, Cohen DJ, Kleiman NS (2007). "Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents". JAMA : the Journal of the American Medical Association. 297 (18): 2001–9. doi:10.1001/jama.297.18.2001. PMID 17488965. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  55. ↑ Berger PB, Bell MR, Hasdai D, Grill DE, Melby S, Holmes DR (1999). "Safety and efficacy of ticlopidine for only 2 weeks after successful intracoronary stent placement". Circulation. 99 (2): 248–53. PMID 9892591. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  56. ↑ Cruden NL, Harding SA, Flapan AD, Graham C, Wild SH, Slack R, Pell JP, Newby DE (2010). "Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery". Circulation. Cardiovascular Interventions. 3 (3): 236–42. doi:10.1161/CIRCINTERVENTIONS.109.934703. PMID 20442357. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  57. ↑ 57.0 57.1 Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF (2009). "2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery". Journal of the American College of Cardiology. 54 (22): e13–e118. doi:10.1016/j.jacc.2009.07.010. PMID 19926002. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  58. ↑ Reddy PR, Vaitkus PT (2005). "Risks of noncardiac surgery after coronary stenting". The American Journal of Cardiology. 95 (6): 755–7. doi:10.1016/j.amjcard.2004.11.029. PMID 15757604. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  59. ↑ Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, Melby S, Berger PB (2003). "Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting". Journal of the American College of Cardiology. 42 (2): 234–40. PMID 12875757. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  60. ↑ Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW (2007). "ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery". Journal of the American College of Cardiology. 50 (17): 1707–32. doi:10.1016/j.jacc.2007.09.001. PMID 17950159. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  61. ↑ Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM (2004). "Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty". Journal of the American College of Cardiology. 43 (6): 936–42. doi:10.1016/j.jacc.2003.10.039. PMID 15028347. Retrieved 2011-12-10. Unknown parameter |month= ignored (help)
  62. ↑ Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J (1997). "Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study". Circulation. 96 (1): 91–8. PMID 9236422. Retrieved 2011-12-10. Unknown parameter |month= ignored (help)
  63. ↑ Stone GW, de Marchena E, Dageforde D, Foschi A, Muhlestein JB, McIvor M, Rizik D, Vanderlaan R, McDonnell J (1997). "Prospective, randomized, multicenter comparison of laser-facilitated balloon angioplasty versus stand-alone balloon angioplasty in patients with obstructive coronary artery disease. The Laser Angioplasty Versus Angioplasty (LAVA) Trial Investigators". Journal of the American College of Cardiology. 30 (7): 1714–21. PMID 9385898. Retrieved 2011-12-10. Unknown parameter |month= ignored (help)
  64. ↑ Noble S, Bilodeau L (2008). "High energy excimer laser to treat coronary in-stent restenosis in an underexpanded stent". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 71 (6): 803–7. doi:10.1002/ccd.21490. PMID 18324694. Retrieved 2011-12-10. Unknown parameter |month= ignored (help)
  65. ↑ Eisenberg MJ, Blankenship JC, Huynh T, Azrin M, Pathan A, Sedlis S, Panja M, Starling MR, Beyar R, Azoulay A, Caron J, Pilote L (2004). "Evaluation of routine functional testing after percutaneous coronary intervention". The American Journal of Cardiology. 93 (6): 744–7. doi:10.1016/j.amjcard.2003.11.071. PMID 15019882. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  66. ↑ Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ (2011). "Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community". Circulation. 123 (21): 2344–52. doi:10.1161/CIRCULATIONAHA.110.983536. PMID 21576654. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  67. ↑ Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N (2004). "Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials". The American Journal of Medicine. 116 (10): 682–92. doi:10.1016/j.amjmed.2004.01.009. PMID 15121495. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  68. ↑ Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, Chieffo C, Gattone M, Griffo R, Schweiger C, Tavazzi L, Urbinati S, Valagussa F, Vanuzzo D (2008). "Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network". Archives of Internal Medicine. 168 (20): 2194–204. doi:10.1001/archinte.168.20.2194. PMID 19001195. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  69. ↑ Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL (2004). "Cardiac rehabilitation after myocardial infarction in the community". Journal of the American College of Cardiology. 44 (5): 988–96. doi:10.1016/j.jacc.2004.05.062. PMID 15337208. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  70. ↑ Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T (2001). "Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association". Circulation. 104 (14): 1694–740. PMID 11581152. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  71. ↑ Thompson PD (2003). "Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease". Arteriosclerosis, Thrombosis, and Vascular Biology. 23 (8): 1319–21. doi:10.1161/01.ATV.0000087143.33998.F2. PMID 12909570. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  72. ↑ Clark AM, Hartling L, Vandermeer B, McAlister FA (2005). "Meta-analysis: secondary prevention programs for patients with coronary artery disease". Annals of Internal Medicine. 143 (9): 659–72. PMID 16263889. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  73. ↑ 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)
  74. ↑ 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)

Template:WH Template:WS

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.[2][3] (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.[2][4][5][6][7] (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.[2] (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.[2] (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. ↑ 1.0 1.1 1.2 1.3 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 2.3 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)
  3. ↑ 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)
  4. ↑ 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)
  5. ↑ 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)
  6. ↑ 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)
  7. ↑ 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)
  8. ↑ 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)
  9. ↑ Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM et al. (2009) 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 54 (23):2205-41. DOI:10.1016/j.jacc.2009.10.015 PMID:19942100


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