Unstable angina non ST elevation myocardial infarction recommendations for PCI: Difference between revisions
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Overview of Recommendations for PCI in UA / NSTEMI
ACC / AHA Guidelines (DO NOT EDIT) [1]
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Class I1. An early invasive PCI strategy is indicated for patients with UA / NSTEMI who have no serious comorbidity and who have coronary lesions amenable to PCI and any of the high risk features. 2. Percutaneous coronary intervention (or CABG) is recommended for UA / NSTEMI patients with 1 or 2 vessel CAD with or without significant proximal left anterior descending CAD but with a large area of viable myocardium and high risk criteria on non invasive testing. (Level of Evidence: B) 3. Percutaneous coronary intervention (or CABG) is recommended for UA/NSTEMI patients with multi vessel coronary disease with suitable coronary anatomy, with normal LV function, and without diabetes mellitus. (Level of Evidence: A) 4. An intravenous platelet GP IIb/IIIa inhibitor is generally recommended in UA/NSTEMI patients undergoing PCI. (Level of Evidence: A) Class IIa1. Percutaneous coronary intervention is reasonable for focal saphenous vein graft (SVG) lesions or multiple stenoses in UA / NSTEMI patients who are undergoing medical therapy and who are poor candidates for reoperative surgery. (Level of Evidence: C) 2. Percutaneous coronary intervention (or CABG) is reasonable for UA / NSTEMI patients with 1 or 2 vessel CAD with or without significant proximal left anterior descending CAD but with a moderate area of viable myocardium and ischemia on noninvasive testing. (Level of Evidence: B) 3. Percutaneous coronary intervention (or CABG) can be beneficial compared with medical therapy for UA / NSTEMI patients with 1 vessel disease with significant proximal left anterior descending CAD. (Level of Evidence: B) 4. Use of PCI is reasonable in patients with UA / NSTEMI with significant left main CAD (>50% diameter stenosis) who are candidates for revascularization but are not eligible for CABG or who require emergent intervention at angiography for hemodynamic instability. (Level of Evidence: B) Class IIb1. In the absence of high-risk features associated with UA / NSTEMI, PCI may be considered in patients with single-vessel or multi vessel 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. Percutaneous coronary intervention may be considered for UA / NSTEMI patients who are undergoing medical therapy who have 2 or 3 vessel disease, significant proximal left anterior descending CAD, and treated diabetes or abnormal LV function, with anatomy suitable for catheter based therapy. (Level of Evidence: B) Class III1. Percutaneous coronary intervention (or CABG) is not recommended for patients with 1 or 2 vessel CAD without significant proximal left anterior descending CAD with no current symptoms or symptoms that are unlikely to be due to myocardial ischemia and who have no ischemia on noninvasive testing. (Level of Evidence: C) 2. In the absence of high risk features associated with UA / NSTEMI, PCI is not recommended for patients with UA / NSTEMI who have single vessel or multi vessel CAD and no trial of medical therapy, or who have one or more of the following:
3. A PCI strategy in stable patients with persistently occluded infarct related coronary arteries after NSTEMI is not indicated. (Level of Evidence: B) |
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See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
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