Risks stratification and benefits of PCI: Difference between revisions
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{{ | __NOTOC__ | ||
{{ | {{PCI}} | ||
{{CMG}}; {{AE}} Xin Yang, MA(Cantab), MB BChir, MRCP(Lond) {{Anahita}} | |||
==Overview== | |||
' | There are several risk assessment scores which can help in determining a patient's risk for [[death]], [[myocardial infarction]] and recurrent cardiac events. | ||
==Risks Stratification and Benefits of PCI== | |||
===Risk Score Assessment=== | |||
==Risk | ====[[The TIMI risk score for STEMI|The TIMI Risk Score for STEMI]]==== | ||
===[[The TIMI Risk Score for | ====[[The TIMI risk score for UA/NSTEMI|The TIMI Risk Score for UA/NSTEMI]]==== | ||
===[[The | ====[[The GRACE risk score|The GRACE Risk Score]]==== | ||
=== | ===Risk Stratification Tools=== | ||
==[[Chronic stable angina risk stratification|Risk Stratification in the Patient with Stable Angina]]== | ====[[Chronic stable angina risk stratification|Risk Stratification in the Patient with Stable Angina]]==== | ||
==[[Risk Stratification in the Patient with Unstable Angina or Non ST Elevation MI]]== | ====[[Unstable angina / non ST elevation myocardial infarction risk stratification and prognosis|Risk Stratification in the Patient with Unstable Angina or Non ST Elevation MI]]==== | ||
==[[Risk Stratification in the Patient with ST Elevation MI]]== | ====[[ST elevation myocardial infarction risk stratification|Risk Stratification in the Patient with ST Elevation MI]]==== | ||
===Benefits of PCI vs Medical Therapy=== | |||
[[Category: | ====[[Chronic stable angina percutaneous coronary intervention versus medical therapy|In Patients With Stable Angina]]==== | ||
====[[Unstable angina / non ST elevation myocardial infarction initial conservative versus initial invasive strategies|In Patients With Unstable Angina or Non ST Elevation MI]]==== | |||
====[[ST elevation myocardial infarction primary percutaneous coronary intervention#Fibrinolysis versus PTCA|In Patients With ST Elevation MI]]==== | |||
==Benefits of Rescue PCI== | |||
Studies demonstrated that rescue [[PCI]] after failed [[fibrinolytic therapy]] is related to a lower risk of [[Cardiovascular disease|cardiovascular events]] when compared to repeated [[fibrinolytic therapy]] or conservative managements.<ref name="pmid15261920">{{cite journal| author=Sutton AG, Campbell PG, Graham R, Price DJ, Gray JC, Grech ED | display-authors=etal| title=A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: the Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial. | journal=J Am Coll Cardiol | year= 2004 | volume= 44 | issue= 2 | pages= 287-96 | pmid=15261920 | doi=10.1016/j.jacc.2003.12.059 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15261920 }} </ref><ref name="pmid17258087">{{cite journal| author=Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO | display-authors=etal| title=Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 4 | pages= 422-30 | pmid=17258087 | doi=10.1016/j.jacc.2006.09.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17258087 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=17608376 Review in: ACP J Club. 2007 Jul-Aug;147(1):11] </ref><ref name="pmid17010790">{{cite journal| author=Collet JP, Montalescot G, Le May M, Borentain M, Gershlick A| title=Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy. | journal=J Am Coll Cardiol | year= 2006 | volume= 48 | issue= 7 | pages= 1326-35 | pmid=17010790 | doi=10.1016/j.jacc.2006.03.064 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17010790 }} </ref><ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | |||
*However, rates of [[Complication (medicine)|complications]] such as [[stroke]] and [[bleeding]] were higher in the rescue [[PCI]] group.<ref name="pmid15261920">{{cite journal| author=Sutton AG, Campbell PG, Graham R, Price DJ, Gray JC, Grech ED | display-authors=etal| title=A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: the Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial. | journal=J Am Coll Cardiol | year= 2004 | volume= 44 | issue= 2 | pages= 287-96 | pmid=15261920 | doi=10.1016/j.jacc.2003.12.059 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15261920 }} </ref><ref name="pmid17258087">{{cite journal| author=Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO | display-authors=etal| title=Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 4 | pages= 422-30 | pmid=17258087 | doi=10.1016/j.jacc.2006.09.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17258087 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=17608376 Review in: ACP J Club. 2007 Jul-Aug;147(1):11] </ref> | |||
*On the other hand, the fact that those studies have been done in the era of [[femoral artery]] access and limited [[Antiplatelet drug|antiplatelet]] and [[anticoagulant]] [[therapy|therapies]] may explain the higher rates of [[stroke]] and [[bleeding]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | |||
*Half-[[dose]] [[tenecteplase]] in [[patients]] [[Old age|older]] than 75 years old reduces the risk of [[stroke]].<ref name="pmid23473396">{{cite journal| author=Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y | display-authors=etal| title=Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 15 | pages= 1379-87 | pmid=23473396 | doi=10.1056/NEJMoa1301092 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473396 }} </ref> | |||
*Furthermore, [[radial artery]] access instead of [[femoral artery]] or avoiding routine use of [[glycoprotein IIb/IIIa inhibitors]] could be used to decrease the risk of [[bleeding]].<ref name="pmid30354598">{{cite journal| author=Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J | display-authors=etal| title=An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. | journal=Circ Cardiovasc Interv | year= 2018 | volume= 11 | issue= 9 | pages= e000035 | pmid=30354598 | doi=10.1161/HCV.0000000000000035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30354598 }} </ref> | |||
==References== | |||
{{reflist|2}} | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
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Latest revision as of 02:51, 9 April 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Xin Yang, MA(Cantab), MB BChir, MRCP(Lond) Anahita Deylamsalehi, M.D.[2]
Overview
There are several risk assessment scores which can help in determining a patient's risk for death, myocardial infarction and recurrent cardiac events.
Risks Stratification and Benefits of PCI
Risk Score Assessment
The TIMI Risk Score for STEMI
The TIMI Risk Score for UA/NSTEMI
The GRACE Risk Score
Risk Stratification Tools
Risk Stratification in the Patient with Stable Angina
Risk Stratification in the Patient with Unstable Angina or Non ST Elevation MI
Risk Stratification in the Patient with ST Elevation MI
Benefits of PCI vs Medical Therapy
In Patients With Stable Angina
In Patients With Unstable Angina or Non ST Elevation MI
In Patients With ST Elevation MI
Benefits of Rescue PCI
Studies demonstrated that rescue PCI after failed fibrinolytic therapy is related to a lower risk of cardiovascular events when compared to repeated fibrinolytic therapy or conservative managements.[1][2][3][4]
- However, rates of complications such as stroke and bleeding were higher in the rescue PCI group.[1][2]
- On the other hand, the fact that those studies have been done in the era of femoral artery access and limited antiplatelet and anticoagulant therapies may explain the higher rates of stroke and bleeding.[4]
- Half-dose tenecteplase in patients older than 75 years old reduces the risk of stroke.[5]
- Furthermore, radial artery access instead of femoral artery or avoiding routine use of glycoprotein IIb/IIIa inhibitors could be used to decrease the risk of bleeding.[6]
References
- ↑ 1.0 1.1 Sutton AG, Campbell PG, Graham R, Price DJ, Gray JC, Grech ED; et al. (2004). "A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: the Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial". J Am Coll Cardiol. 44 (2): 287–96. doi:10.1016/j.jacc.2003.12.059. PMID 15261920.
- ↑ 2.0 2.1 Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO; et al. (2007). "Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials". J Am Coll Cardiol. 49 (4): 422–30. doi:10.1016/j.jacc.2006.09.033. PMID 17258087. Review in: ACP J Club. 2007 Jul-Aug;147(1):11
- ↑ Collet JP, Montalescot G, Le May M, Borentain M, Gershlick A (2006). "Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy". J Am Coll Cardiol. 48 (7): 1326–35. doi:10.1016/j.jacc.2006.03.064. PMID 17010790.
- ↑ 4.0 4.1 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). - ↑ Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y; et al. (2013). "Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction". N Engl J Med. 368 (15): 1379–87. doi:10.1056/NEJMoa1301092. PMID 23473396.
- ↑ Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J; et al. (2018). "An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association". Circ Cardiovasc Interv. 11 (9): e000035. doi:10.1161/HCV.0000000000000035. PMID 30354598.