Chronic stable angina revascularization with PCI and CABG in asymptomatic patients: Difference between revisions

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(/* ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT){{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=ACC/AHA 2002 guideline update for th...)
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{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]];  Smita Kohli, M.D.


==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960  }} </ref><ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>==
===Revascularization with PCI and CABG in Asymptomatic Patients (DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960  }} </ref><ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] for patients with significant left main coronary disease. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[CABG]] for patients with three-vessel disease. The survival benefit is greater in patients with abnormal [[LV function]] (ejection fraction less than 50%). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[CABG]] for patients with two-vessel disease with significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] and either abnormal [[LV function]] (ejection fraction less than 50%) or demonstrable [[ischemia]] on noninvasive testing. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' [[PCI]] for patients with two- or three-vessel disease with significant proximal [[left anterior descending artery|Left anterior descending]] [[CAD]] who have anatomy suitable for catheter based therapy and normal [[LV function]] and who do not have treated [[diabetes]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' [[PCI]] or [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] but with a large area of viable myocardium and high-risk criteria on non-invasive testing. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] who have survived sudden cardiac death or sustained [[ventricular tachycardia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' In patients with prior [[PCI]], [[CABG]] or [[PCI]] for recurrent stenosis associated with a large area of viable myocardium or high-risk criteria on noninvasive testing. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|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.''' Use of [[PCI]] or [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] and
|-
| bgcolor="LightCoral"|'''a.''' only a small area of viable myocardium or
|-
| bgcolor="LightCoral"|'''b.''' no demonstrable [[ischemia]] on noninvasive testing. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Use of [[PCI]] or [[CABG]] for patients with borderline coronary stenoses (50% to 60% diameter in locations other than the left main coronary artery) and no demonstrable [[ischemia]] on noninvasive testing. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' Use of [[PCI]] or [[CABG]] for patients with insignificant coronary stenosis (less than 50% diameter). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.''' Use of [[PCI]] in patients with significant left main [[CAD]] who are candidates for [[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 IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[PCI]] or [[CABG]] for patients with one-vessel disease with significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]]. ''([[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 IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Compared with [[CABG]], [[PCI]] for patients with two or three vessel disease with significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] who have anatomy suitable for catheter-based therapy and who have treated [[diabetes]] or abnormal [[LV function]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Use of [[PCI]] for patients with significant left main coronary disease who are not candidates for [[CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' [[PCI]] for patients with one or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] who have survived sudden cardiac death or sustained ventricular tachycardia. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' Repeat [[CABG]] for patients with multiple saphenous vein graft stenoses, with high-risk criteria on noninvasive testing, especially when there is significant stenosis of a graft supplying the [[left anterior descending artery|LAD]]. [[PCI]] may be appropriate for focal saphenous vein graft lesions or multiple stenoses in poor candidates for reoperative surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' [[PCI]] or [[CABG]] for patients with one- or two-vessel [[CAD]] without significant proximal [[left anterior descending artery|left anterior descending]] [[CAD]] but with a moderate area of viable myocardium and demonstrable [[ischemia]] on noninvasive testing. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
==See Also==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
==Guidelines Resources==
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>
*The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</ref>
==References==
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Latest revision as of 16:40, 4 December 2012