Chronic stable angina revascularization percutaneous coronary intervention indications: Difference between revisions
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{{Chronic stable angina}} | {{Chronic stable angina}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Lakshmi Gopalakrishnan, M.B.B.S.]] | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Lakshmi Gopalakrishnan, M.B.B.S.]] | ||
== | ==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>== | ||
===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>=== | |||
{|class="wikitable" | |||
|- | |||
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] | |||
|- | |||
|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: | |||
:'''a.''' Only a small area of viable myocardium at risk. ''([[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]])'' | |||
:'''c.''' Lesions that have a low likelihood of successful dilatation. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | |||
:'''d.''' Mild symptoms that are unlikely to be due to [[myocardial ischemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | |||
:'''e.''' Factors associated with increased risk of morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | |||
:'''f.''' [[Left main]] [[CAD|disease]] and eligibility for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | |||
:'''g.''' Insignificant disease (less than 50% coronary [[stenosis]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" | |||
: | |- | ||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<nowiki>"</nowiki>'''1.''' [[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]] and with 1 or more significant lesions in 1 or 2 coronary arteries suitable for PCI with a high likelihood of success and a low risk of morbidity and mortality. The vessels to be dilated must subtend a moderate to large area of viable myocardium or be associated with a moderate to severe degree of ischemia on [[Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing|noninvasive testing]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<nowiki>"</nowiki>'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable 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]], and recurrent stenosis after PCI with a large area of viable myocardium or [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|high-risk criteria on noninvasive testing]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<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> | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<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> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<nowiki>"</nowiki>'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] might be considered 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]] with non-proximal [[LAD]] [[CAD]] that subtends a moderate area of viable myocardium and demonstrates [[ischemia]] on | |||
[[Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing|noninvasive testing]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|} | |||
===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>=== | |||
{|class="wikitable" | |||
|- | |||
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] | |||
|- | |||
|bgcolor="LightCoral"| | |||
<nowiki>"</nowiki>'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is not recommended for patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] with single-vessel or multivessel [[CAD]], no evidence of myocardial injury or [[ischemia]] on objective testing, and no trial of [[Chronic stable angina pharmacotherapy overview|medical therapy]], or who have 1 of the following: | |||
:'''a.''' Only a small area of myocardium at risk. ''([[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]])'' | |||
:'''c.''' A high risk of procedure-related morbidity or mortality. ''([[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]])'' | |||
:'''e.''' Significant [[left main]] [[CAD]] and candidacy for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<nowiki>"</nowiki>'''1.''' 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> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<nowiki>"</nowiki>'''2.''' 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]] with single-vessel or multi-vessel [[CAD]] who are undergoing medical therapy with focal saphenous vein graft lesions or multiple stenoses who are poor candidates for reoperative surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<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> | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<nowiki>"</nowiki>'''1.''' [[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]] with single-vessel or multivessel [[CAD]] who are undergoing [[Chronic stable angina pharmacotherapy overview|medical therapy]] and who have 1 or more lesions to be dilated with a reduced likelihood of success. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
<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> | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
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[[Category:Up | [[Category:Up-To-Date cardiology]] | ||
Latest revision as of 19:31, 5 February 2013
Chronic stable angina Microchapters | ||
Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
Diagnosis | ||
Alternative Therapies for Refractory Angina | ||
Discharge Care | ||
Guidelines for Asymptomatic Patients | ||
Case Studies | ||
Chronic stable angina revascularization percutaneous coronary intervention indications On the Web | ||
FDA on Chronic stable angina revascularization percutaneous coronary intervention indications | ||
CDC onChronic stable angina revascularization percutaneous coronary intervention indications | ||
Chronic stable angina revascularization percutaneous coronary intervention indications in the news | ||
Blogs on Chronic stable angina revascularization percutaneous coronary intervention indications | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.
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)[1]
Asymptomatic Ischemia or CCS Class I or II Angina (DO NOT EDIT)[1]
Class III |
"1. PCI is not recommended in patients with asymptomatic ischemia or 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:
|
Class IIa |
"1. PCI is reasonable in patients with asymptomatic ischemia or CCS class I or II angina and with 1 or more significant lesions in 1 or 2 coronary arteries suitable for PCI with a high likelihood of success and a low risk of morbidity and mortality. The vessels to be dilated must subtend a moderate to large area of viable myocardium or be associated with a moderate to severe degree of ischemia on noninvasive testing. (Level of Evidence: B)" |
"2. PCI is reasonable for patients with asymptomatic ischemia or CCS class I or II angina, and recurrent stenosis after PCI with a large area of viable myocardium or high-risk criteria on noninvasive testing. (Level of Evidence: C)" |
"3. Use of PCI is reasonable in patients with asymptomatic ischemia or CCS class I or II angina with significant left main CAD (greater than 50% diameterstenosis) who are candidates for revascularization but are not eligible for CABG. (Level of Evidence: B)" |
Class IIb |
"1. The effectiveness of PCI for patients with asymptomatic ischemia or CCS class I or II angina who have 2- or 3-vessel disease with significantproximal LAD CAD who are otherwise eligible for CABGwith 1 arterial conduit and who have treated diabetes or abnormal LV function is not well established. (Level of Evidence: B)" |
"2. PCI might be considered for patients with asymptomatic ischemia or CCS class I or II angina with non-proximal LAD CAD that subtends a moderate area of viable myocardium and demonstrates ischemia on noninvasive testing. (Level of Evidence: C)" |
CCS Class III Angina (DO NOT EDIT)[1]
Class III |
"1. PCI is not recommended for patients with CCS class III angina with single-vessel or multivessel CAD, no evidence of myocardial injury or ischemia on objective testing, and no trial of medical therapy, or who have 1 of the following:
|
Class IIa |
"1. It is reasonable that PCI be performed in patients with CCS class III angina and single-vessel or multi-vessel CAD who are undergoing medical therapy and who have 1 or more significant lesions in 1 or more coronary arteries suitable for PCI with a high likelihood of success and low risk of morbidity or mortality. (Level of Evidence: B)" |
"2. It is reasonable that PCI be performed in patients with CCS class III angina with single-vessel or multi-vessel CAD who are undergoing medical therapy with focal saphenous vein graft lesions or multiple stenoses who are poor candidates for reoperative surgery. (Level of Evidence: C)" |
"3. Use of PCI is reasonable in patients with CCS class III angina with significant left main CAD(greater than 50% diameter stenosis) who are candidates for revascularization but are not eligible for CABG. (Level of Evidence: B)" |
Class IIb |
"1. PCI may be considered in patients with CCS class III angina with single-vessel or multivessel CAD who are undergoing medical therapy and who have 1 or more lesions to be dilated with a reduced likelihood of success. (Level of Evidence: B)" |
"2. PCI may be considered in patients with CCS class III angina and no evidence of ischemia on noninvasive testing or who are undergoing medical therapy and have 2- or 3-vessel CAD with significant proximal LAD CAD and treated diabetes or abnormal LV function. (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 1.2 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)