Percutaneous coronary intervention revascularization to improve symptoms

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Percutaneous Coronary Intervention Guidelines Microchapters

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Patient Information

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]

Overview

2011 ACCF/AHA Guidelines for Revascularization to Improve Symptoms[1]

Class I

"1. CABG orPCI 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. [2][3][4][5][6][7][8][9][10][11][12] (Level of Evidence: A)"

Class III (Harm)

"1. CABG orPCI 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

"1. CABG orPCI 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)"

"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. [13][14][15] (Level of Evidence: C)"

"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. [16][17][18][19](Level of Evidence: B)"

Class IIb

"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. [20] (Level of Evidence: C)"

References

  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. ↑ Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS (2007). "Optimal medical therapy with or without PCI for stable coronary disease". The New England Journal of Medicine. 356 (15): 1503–16. doi:10.1056/NEJMoa070829. PMID 17387127. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  3. ↑ "Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial". Lancet. 358 (9286): 951–7. 2001. doi:10.1016/S0140-6736(01)06100-1. PMID 11583747. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  4. ↑ Benzer W, Höfer S, Oldridge NB (2003). "Health-related quality of life in patients with coronary artery disease after different treatments for angina in routine clinical practice". Herz. 28 (5): 421–8. doi:10.1007/s00059-003-2388-9. PMID 12928741. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  5. ↑ Bonaros N, Schachner T, Ohlinger A, Friedrich G, Laufer G, Bonatti J (2005). "Assessment of health-related quality of life after coronary revascularization". The Heart Surgery Forum. 8 (5): E380–5. doi:10.1532/HSF98.20051139. PMID 16174598. Retrieved 2011-12-06.
  6. ↑ Bucher HC, Hengstler P, Schindler C, Guyatt GH (2000). "Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials". BMJ (Clinical Research Ed.). 321 (7253): 73–7. PMC 27425. PMID 10884254. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  7. ↑ Favarato ME, Hueb W, Boden WE, Lopes N, Nogueira CR, Takiuti M, Góis AF, Borges JC, Favarato D, Aldrighi JM, Oliveira SA, Ramires JA (2007). "Quality of life in patients with symptomatic multivessel coronary artery disease: a comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS II trial". International Journal of Cardiology. 116 (3): 364–70. doi:10.1016/j.ijcard.2006.06.001. PMID 16876891. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  8. ↑ Hueb W, Lopes N, Gersh BJ, Soares PR, Ribeiro EE, Pereira AC, Favarato D, Rocha AS, Hueb AC, Ramires JA (2010). "Ten-year follow-up survival of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease". Circulation. 122 (10): 949–57. doi:10.1161/CIRCULATIONAHA.109.911669. PMID 20733102. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  9. ↑ Pocock SJ, Henderson RA, Seed P, Treasure T, Hampton JR (1996). "Quality of life, employment status, and anginal symptoms after coronary angioplasty or bypass surgery. 3-year follow-up in the Randomized Intervention Treatment of Angina (RITA) Trial". Circulation. 94 (2): 135–42. PMID 8674171. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  10. ↑ Pocock SJ, Henderson RA, Clayton T, Lyman GH, Chamberlain DA (2000). "Quality of life after coronary angioplasty or continued medical treatment for angina: three-year follow-up in the RITA-2 trial. Randomized Intervention Treatment of Angina". Journal of the American College of Cardiology. 35 (4): 907–14. PMID 10732887. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  11. ↑ Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, Zhang W, Hartigan PM, Lewis C, Veledar E, Bowen J, Dunbar SB, Deaton C, Kaufman S, O'Rourke RA, Goeree R, Barnett PG, Teo KK, Boden WE, Mancini GB (2008). "Effect of PCI on quality of life in patients with stable coronary disease". The New England Journal of Medicine. 359 (7): 677–87. doi:10.1056/NEJMoa072771. PMID 18703470. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  12. ↑ Wijeysundera HC, Nallamothu BK, Krumholz HM, Tu JV, Ko DT (2010). "Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief". Annals of Internal Medicine. 152 (6): 370–9. doi:10.1059/0003-4819-152-6-201003160-00007. PMID 20231568. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  13. ↑ Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA (2007). "Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery". International Journal of Cardiology. 119 (1): 65–72. doi:10.1016/j.ijcard.2006.07.058. PMID 17045681. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  14. ↑ Pfautsch P, Frantz E, Ellmer A, Sauer HU, Fleck E (1999). "[Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization]". Zeitschrift Für Kardiologie (in German). 88 (7): 489–97. PMID 10467648. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  15. ↑ Subramanian S, Sabik JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW (2009). "Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending". The Annals of Thoracic Surgery. 87 (5): 1392–8, discussion 1400. doi:10.1016/j.athoracsur.2009.02.032. PMID 19379872. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  16. ↑ Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH (2008). "Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease". The New England Journal of Medicine. 358 (4): 331–41. doi:10.1056/NEJMoa071804. PMID 18216353. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  17. ↑ Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A (2011). "Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial". European Heart Journal. 32 (17): 2125–34. doi:10.1093/eurheartj/ehr213. PMID 21697170. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  18. ↑ Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS (2004). "Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features". Circulation. 109 (19): 2290–5. doi:10.1161/01.CIR.0000126826.58526.14. PMID 15117846. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  19. ↑ Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA (2005). "Long-term outcomes of coronary-artery bypass grafting versus stent implantation". The New England Journal of Medicine. 352 (21): 2174–83. doi:10.1056/NEJMoa040316. PMID 15917382. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  20. ↑ Weintraub WS, Jones EL, Morris DC, King SB, Guyton RA, Craver JM (1997). "Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery". Circulation. 95 (4): 868–77. PMID 9054744. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)

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