Coronary revascularization: Difference between revisions
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**An estimated diameter [[stenosis]] more than 70% for non-[[Left main coronary artery|left main]] [[disease]]. | **An estimated diameter [[stenosis]] more than 70% for non-[[Left main coronary artery|left main]] [[disease]]. | ||
**An estimated diameter [[stenosis]] more than 50% for [[Left main coronary artery|left main]] [[disease]]. | **An estimated diameter [[stenosis]] more than 50% for [[Left main coronary artery|left main]] [[disease]]. | ||
**For [[stenosis]] more than 40% but less than 69% more investigations are required. | |||
*The fact that whether visually estimated diameter [[stenosis]] or quantitative [[coronary angiography]] can better predict the the functional significance of a [[coronary stenosis]] is controversial. <ref name="pmid28687539">{{cite journal| author=Adjedj J, Xaplanteris P, Toth G, Ferrara A, Pellicano M, Ciccarelli G | display-authors=etal| title=Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve: The Impact of Risk Factors. | journal=Circ Cardiovasc Imaging | year= 2017 | volume= 10 | issue= 7 | pages= | pmid=28687539 | doi=10.1161/CIRCIMAGING.117.006243 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28687539 }} </ref> | |||
*Although the [[lesion]]'s length can affect the [[ischemia]] severity, there are no standard cutoffs for length of the lesions when sever [[stenosis]] is determined. | |||
==Outcome== | ==Outcome== | ||
Revision as of 03:38, 2 March 2022
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Historical Perspective
Classification
Coronary revascularization may refer to;
Indications
- Treatment decisions regarding coronary revascularization should be done regardless of sex, race, and ethnicity.[1]
- Decision regarding coronary revascularization should be patient-centered, meaning that physicians should consider patient's wishes, health literacy, and cultural believes.[1]
- Based on ACC/AHA/SCAI 2021 guideline, for patients with unclear optimal treatment strategy a Heart Team including an interventional cardiologist, cardiac surgeon, and clinical cardiologist is recommended to assess the patient's outcome. The following table demonstrates factors that can be considered by the Heart Team:[1]
| Coronary Anatomy | *Left main disease *Multivessel disease *Complicated anatomy (such as bifurcation disease, and high SYNTAX score |
|---|---|
| Comorbidities | *Coagulopathy *Frailty *Diabetes *Valvular heart disease *Cancer *Systolic dysfunction *End-stage renal disease *Aortic aneurysm *Calcified aorta *Immunosuppression *Chronic obstructive pulmonary disease *History of cerebral stroke *Debilitating neurological disorders *Cirrhosis/liver disease |
| Procedure | *Access site for percutaneous coronary intervention (PCI) *Risk of surgery *Local and regional clinical outcomes *Risk of percutaneous coronary intervention (PCI) |
| Patient | *Patient preferences, religional believes, education, and knowledge *Incompliant to dual antiplatelet therapy *Patient social supports *Unstable presentation or shock |
Coronary Anatomy
- Based on ACC 2021 guideline, coronary angiography is still the default method to determine coronary anatomy and stenosis degree.[1]
- Significant stenosis is one of the indications for the revascularization procedure, which has been defined as the following observations in coronary angiography:[1]
- The fact that whether visually estimated diameter stenosis or quantitative coronary angiography can better predict the the functional significance of a coronary stenosis is controversial. [2]
- Although the lesion's length can affect the ischemia severity, there are no standard cutoffs for length of the lesions when sever stenosis is determined.
Outcome
- After controlling baseline comorbidities and treatment strategies, outcome of coronary revascularization were same among different races as well as males and females.[1][3][4]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ Adjedj J, Xaplanteris P, Toth G, Ferrara A, Pellicano M, Ciccarelli G; et al. (2017). "Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve: The Impact of Risk Factors". Circ Cardiovasc Imaging. 10 (7). doi:10.1161/CIRCIMAGING.117.006243. PMID 28687539.
- ↑ O'Donoghue M, Boden WE, Braunwald E, Cannon CP, Clayton TC, de Winter RJ; et al. (2008). "Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis". JAMA. 300 (1): 71–80. doi:10.1001/jama.300.1.71. PMID 18594042. Review in: ACP J Club. 2008 Nov 18;149(5):7 Review in: Evid Based Med. 2009 Feb;14(1):19
- ↑ Tamis-Holland JE, Palazzo A, Stebbins AL, Slater JN, Boland J, Ellis SG; et al. (2004). "Benefits of direct angioplasty for women and men with acute myocardial infarction: results of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes Angioplasty (GUSTO II-B) Angioplasty Substudy". Am Heart J. 147 (1): 133–9. doi:10.1016/j.ahj.2003.06.002. PMID 14691431.