Chronic stable angina risk stratification coronary angiography

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.

ACC / AHA Guidelines- Who Should Undergo Coronary Angiography and Left Ventriculography for Risk Stratification (DO NOT EDIT)

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Class I 1. Patients with disabling (Canadian Cardiovascular Society (CCS) classes III and IV) chronic stable angina despite medical therapy. (Level of Evidence: B) 2. Patients with high-risk criteria on noninvasive testing regardless of anginal severity. (Level of Evidence: B) 3. Patients with angina who have survived sudden cardiac death or serious ventricular arrhythmia. (Level of Evidence: B) 4. Patients with angina and symptoms and signs of congestive heart failure. (Level of Evidence: C) 5. Patients with clinical characteristics that indicate a high likelihood of severe CAD. (Level of Evidence: C) Class IIa 1. Patients with significant LV dysfunction (ejection fraction <45%), CCS class I or II angina, and demonstrable ischemia but less than high-risk criteria on noninvasive testing. (Level of Evidence: C) 2. Patients with inadequate prognostic information after noninvasive testing. (Level of Evidence: C) Class IIb 1. Patients with CCS class I or II angina, preserved LV function (ejection fraction >45%), and less than high-risk criteria on noninvasive testing. (Level of Evidence: C) Class III 1. Patients with CCS class I or II angina who respond to medical therapy and have no evidence of ischemia on noninvasive testing. (Level of Evidence: C) 2. Patients who prefer to avoid revascularization. (Level of Evidence: C)

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ESC Guidelines- Risk Stratification by Coronary Arteriography (DO NOT EDIT)

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Class I 1. Patients determined to be at high risk for adverse outcome on the basis of non-invasive testing even if they present with mild or moderate symptoms of angina. (Level of Evidence: B) 2. Severe stable angina (Class III of Canadian Cardiovascular Society Classification (CCS), particularly if the symptoms are inadequately responding to medical treatment. (Level of Evidence: B) 3. Stable angina in patients who are being considered for major non-cardiac surgery, especially vascular surgery (repair of aortic aneurysm, femoral bypass, carotid endarterectomy) with intermediate or high risk features on non-invasive testing. (Level of Evidence: B) Class IIa 1. Patients with an inconclusive diagnosis on non-invasive testing, or conflicting results from different noninvasive modalities. (Level of Evidence: C) 2. Patients with a high risk of restenosis after PCI if PCI has been performed in a prognostically important site. (Level of Evidence: C)

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Vote on and Suggest Revisions to the Current Guidelines

• The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Sources

• Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology

• The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina

• TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina

• The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina

References

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