Percutaneous coronary intervention unstable angina / non-ST elevation myocardial infarction (UA/NSTEMI)

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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]

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

Intravenous Antiplatelet Therapy in Unstable Angina/Non-ST Elevation Myocardial Infarction (UA/NSTEMI) (DO NOT EDIT)[1]

Class I
"1. In UA/NSTEMI patients with high-risk features (e.g., elevated troponin level) not treated with bivalirudin and not adequately pre-treated with clopidogrel, it is useful at the time of PCI to administer a GP IIb/IIIa inhibitor (abciximab,double-bolus eptifibatide, or high-bolus dose tirofiban) in patients treated with unfractionated heparin therapy (UFH).[2][3][4][5][6][7] (Level of Evidence: A)"
Class IIa
"1. In UA/NSTEMI patients with high-risk features (e.g., elevated troponin level) treated with unfractionated heparin therapy (UFH) and adequately pretreated with clopidogrel, it is reasonable at the time of PCI to administer a GP IIb/IIIa inhibitor (abciximab,double-bolus eptifibatide, or high-bolus dose tirofiban).[5][8] (Level of Evidence: B)"

References

  1. 1.0 1.1 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. "Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. The EPILOG Investigators". The New England Journal of Medicine. 336 (24): 1689–96. 1997. doi:10.1056/NEJM199706123362401. PMID 9182212. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  3. Boersma E, Akkerhuis KM, Théroux P, Califf RM, Topol EJ, Simoons ML (1999). "Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention". Circulation. 100 (20): 2045–8. PMID 10562258. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  4. Hamm CW, Heeschen C, Goldmann B, Vahanian A, Adgey J, Miguel CM, Rutsch W, Berger J, Kootstra J, Simoons ML (1999). "Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE) Study Investigators". The New England Journal of Medicine. 340 (21): 1623–9. doi:10.1056/NEJM199905273402103. PMID 10341274. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  5. 5.0 5.1 Sosnowski C (2006). "[Commentary to the article: Kastrati A, Mehilli J, Neumann FJ, et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA 2006; 295: 1531-8]". Kardiologia Polska (in Polish). 64 (8): 913–6, discussion 917–8. PMID 16981067. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  6. Roffi M, Chew DP, Mukherjee D, Bhatt DL, White JA, Heeschen C, Hamm CW, Moliterno DJ, Califf RM, White HD, Kleiman NS, Théroux P, Topol EJ (2001). "Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with non-ST-segment-elevation acute coronary syndromes". Circulation. 104 (23): 2767–71. PMID 11733392. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  7. "Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. The EPIC Investigation". The New England Journal of Medicine. 330 (14): 956–61. 1994. doi:10.1056/NEJM199404073301402. PMID 8121459. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  8. Valgimigli M, Percoco G, Barbieri D, Ferrari F, Guardigli G, Parrinello G, Soukhomovskaia O, Ferrari R (2004). "The additive value of tirofiban administered with the high-dose bolus in the prevention of ischemic complications during high-risk coronary angioplasty: the ADVANCE Trial". Journal of the American College of Cardiology. 44 (1): 14–9. doi:10.1016/j.jacc.2004.03.042. PMID 15234398. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)

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