Percutaneous coronary intervention revascularization to improve symptoms
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Percutaneous Coronary Intervention Guidelines Microchapters |
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PCI Approaches: |
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CAD Revascularization: |
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Pre-procedural Considerations: |
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Procedural Considerations: |
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Post-Procedural Considerations: |
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Quality and Performance Considerations: |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]
Revascularization to Improve Symptoms (DO NOT EDIT)[1]
| Class I |
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"1. CABG or PCI 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. (Level of Evidence: A)" |
| Class III (Harm) |
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"1. CABG or PCI to improve symptoms should not be performed in patients who do not meet anatomic (greater than 50% left main or greater than 70% non–left main stenosis) or physiological (e.g., abnormal fractional flow reserve) criteria for revascularization. (Level of Evidence: C)" |
| Class IIa |
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"1. CABG or PCI 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)" |
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"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. (Level of Evidence: C)" |
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"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. (Level of Evidence: B)" |
| Class IIb |
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"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. (Level of Evidence: C)" |
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"2.Transmyocardial laser revascularization performed as an adjunct to CABG to improve symptoms may be reasonable in patients with viable ischemic myocardium that is perfused by arteries that are not amenable to grafting.[2] [3] [4] [5][6] (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B; et al. (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". Circulation. 124 (23): 2574–609. doi:10.1161/CIR.0b013e31823a5596. PMID 22064598.
- ↑ Schofield PM, Sharples LD, Caine N, et al. Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial. Lancet. 1999; 353: 519– 24.
- ↑ Aaberge L, Nordstrand K, Dragsund M, et al. Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris. Clinical results from the Norwegian randomized trial. J Am Coll Cardiol. 2000; 35: 1170– 7.
- ↑ Burkhoff D, Schmidt S, Schulman SP, et al., ATLANTIC Investigators. Transmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomised trial. Angina Treatments-Lasers and Normal Therapies in Comparison. Lancet. 1999; 354: 885– 90.
- ↑ Allen KB, Dowling RD, DelRossi AJ, et al. Transmyocardial laser revascularization combined with coronary artery bypass grafting: a multicenter, blinded, prospective, randomized, controlled trial. J Thorac Cardiovasc Surg. 2000; 119: 540– 9.
- ↑ Stamou SC, Boyce SW, Cooke RH, et al. One-year outcome after combined coronary artery bypass grafting and transmyocardial laser revascularization for refractory angina pectoris. Am J Cardiol. 2002; 89: 1365– 8.