Percutaneous coronary intervention (PCI): Difference between revisions

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{{Template:Percutaneous Coronary Intervention}}
#redirect[[Percutaneous coronary intervention: basic principles and guidelines]]
 
'''For patient information click [[Angioplasty (patient information)|here]]'''
 
{{CMG}}; {{AOEIC}} {{LG}}
 
==Epidemiology and Demographics==
* Approximately 850,000 PCIs are performed each year in the United States.
 
==Classification of Recommendations and Level of Evidence==
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Classification of Recommendations]]:====
 
{{cquote|
 
*'''Class I: Benefit >>> Risk'''
:*Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective.
 
*'''Class II:''' Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.
 
*'''Class IIa: Benefit >> Risk'''
:*Weight of evidence/opinion is in favor of usefulness/efficacy.
 
*'''Class IIb: Benefit ≥ Risk'''
:*Usefulness/efficacy is less well established by evidence/opinion.
 
*'''Class III: Risk ≥ Benefit'''
:*Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful.}}
 
====[[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence]]:====
 
{{cquote|
 
* '''Level of Evidence A:''' Data derived from multiple randomized clinical trials or meta-analyses.
* '''Level of Evidence B:''' Data derived from a single randomized trial, or nonrandomized studies.
* '''Level of Evidence C:''' Only consensus opinion of experts,case studies, or standard-of-care.}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: CAD Revascularization <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08 |url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Heart Team Approach to Revascularization Decisions <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' A Heart Team approach to revascularization is recommended in patients with [[PCI in the unprotected left main patient|unprotected left main]] or [[CAD|complex CAD]]. <ref name="pmid10859284">Feit F, Brooks MM, Sopko G, Keller NM, Rosen A, Krone R et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10859284 Long-term clinical outcome in the Bypass Angioplasty Revascularization Investigation Registry: comparison with the randomized trial. BARI Investigators.] ''Circulation'' 101 (24):2795-802. PMID: [http://pubmed.gov/10859284 10859284]</ref><ref name="pmid9185632">King SB, Barnhart HX, Kosinski AS, Weintraub WS, Lembo NJ, Petersen JY et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9185632 Angioplasty or surgery for multivessel coronary artery disease: comparison of eligible registry and randomized patients in the EAST trial and influence of treatment selection on outcomes. Emory Angioplasty versus Surgery Trial Investigators.] ''Am J Cardiol'' 79 (11):1453-9. PMID: [http://pubmed.gov/9185632 9185632]</ref><ref name="pmid19228612">Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19228612 Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.] ''N Engl J Med'' 360 (10):961-72. [http://dx.doi.org/10.1056/NEJMoa0804626 DOI:10.1056/NEJMoa0804626] PMID: [http://pubmed.gov/19228612 19228612]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' Calculation of the Society of Thoracic Surgeons and [[SYNTAX]] ([[SYNTAX|Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery]]) scores is reasonable in patients with [[PCI in the unprotected left main patient|unprotected left main]] and [[CAD|complex CAD]]. <ref name="pmid19228612">Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19228612 Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.] ''N Engl J Med'' 360 (10):961-72. [http://dx.doi.org/10.1056/NEJMoa0804626 DOI:10.1056/NEJMoa0804626] PMID: [http://pubmed.gov/19228612 19228612]</ref><ref name="pmid21256999">Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21256999 Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization.] ''Am J Cardiol'' 107 (3):360-6. [http://dx.doi.org/10.1016/j.amjcard.2010.09.029 DOI:10.1016/j.amjcard.2010.09.029] PMID: [http://pubmed.gov/21256999 21256999]</ref><ref name="pmid11573040">Grover FL, Shroyer AL, Hammermeister K, Edwards FH, Ferguson TB, Dziuban SW et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11573040 A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases.] ''Ann Surg'' 234 (4):464-72; discussion 472-4. PMID: [http://pubmed.gov/11573040 11573040]</ref><ref name="pmid20630454">Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630454 Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization.] ''JACC Cardiovasc Interv'' 3 (6):612-23. [http://dx.doi.org/10.1016/j.jcin.2010.04.004 DOI:10.1016/j.jcin.2010.04.004] PMID: [http://pubmed.gov/20630454 20630454]</ref><ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID: [http://pubmed.gov/20530001 20530001]</ref><ref name="pmid19559822">Shahian DM, O'Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19559822 The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery.] ''Ann Thorac Surg'' 88 (1 Suppl):S2-22. [http://dx.doi.org/10.1016/j.athoracsur.2009.05.053 DOI:10.1016/j.athoracsur.2009.05.053] PMID: [http://pubmed.gov/19559822 19559822]</ref><ref name="pmid20022608">Shahian DM, O'Brien SM, Normand SL, Peterson ED, Edwards FH (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20022608 Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score.] ''J Thorac Cardiovasc Surg'' 139 (2):273-82. [http://dx.doi.org/10.1016/j.jtcvs.2009.09.007 DOI:10.1016/j.jtcvs.2009.09.007] PMID: [http://pubmed.gov/20022608 20022608]</ref><ref name="pmid17954059">Welke KF, Peterson ED, Vaughan-Sarrazin MS, O'Brien SM, Rosenthal GE, Shook GJ et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17954059 Comparison of cardiac surgery volumes and mortality rates between the Society of Thoracic Surgeons and Medicare databases from 1993 through 2001.] ''Ann Thorac Surg'' 84 (5):1538-46. [http://dx.doi.org/10.1016/j.athoracsur.2007.06.022 DOI:10.1016/j.athoracsur.2007.06.022] PMID: [http://pubmed.gov/17954059 17954059]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Revascularization to Improve Survival: Left Main Coronary Artery Disease <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' [[CABG]] to improve survival is recommended for patients with significant (greater than or equal to 50% diameter [[stenosis]]) [[left main]] coronary artery stenosis. <ref name="pmid7729018">Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7729018 Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience.] ''Circulation'' 91 (9):2325-34. PMID: [http://pubmed.gov/7729018 7729018]</ref><ref name="pmid7025604">Chaitman BR, Fisher LD, Bourassa MG, Davis K, Rogers WJ, Maynard C et al. (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7025604 Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS).] ''Am J Cardiol'' 48 (4):765-77. PMID: [http://pubmed.gov/7025604 7025604]</ref><ref name="pmid11431667">Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11431667 Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators.] ''Am Heart J'' 142 (1):119-26. [http://dx.doi.org/10.1067/mhj.2001.116072 DOI:10.1067/mhj.2001.116072] PMID: [http://pubmed.gov/11431667 11431667]</ref><ref name="pmid791537">Takaro T, Hultgren HN, Lipton MJ, Detre KM (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=791537 The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions.] ''Circulation'' 54 (6 Suppl):III107-17. PMID: [http://pubmed.gov/791537 791537]</ref><ref name="pmid6979435">Takaro T, Peduzzi P, Detre KM, Hultgren HN, Murphy ML, van der Bel-Kahn J et al. (1982) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6979435 Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease.] ''Circulation'' 66 (1):14-22. PMID: [http://pubmed.gov/6979435 6979435]</ref><ref name="pmid2785870">Taylor HA, Deumite NJ, Chaitman BR, Davis KB, Killip T, Rogers WJ (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2785870 Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry.] ''Circulation'' 79 (6):1171-9. PMID: [http://pubmed.gov/2785870 2785870]</ref><ref name="pmid7914958">Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW et al. (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7914958 Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration.] ''Lancet'' 344 (8922):563-70. PMID: [http://pubmed.gov/7914958 7914958]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve survival is reasonable as an alternative to [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] in selected [[chronic stable angina|stable]] patients with significant (greater than or equal to 50% diameter stenosis) [[PCI in the unprotected left main patient|unprotected left main CAD]] with:
 
:'''a.''' Anatomic conditions associated with a low risk of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] procedural complications and a high likelihood of good long-term outcome (e.g., a low [[SYNTAX]] score [lower than or equal to 22], ostial or trunk [[left main]] [[CAD]]); and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' Clinical characteristics that predict a significantly increased risk of adverse surgical outcomes (e.g., Society of Thoracic Surgeons–predicted risk of operative mortality 5%). <ref name="pmid21256999">Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21256999 Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization.] ''Am J Cardiol'' 107 (3):360-6. [http://dx.doi.org/10.1016/j.amjcard.2010.09.029 DOI:10.1016/j.amjcard.2010.09.029] PMID: [http://pubmed.gov/21256999 21256999]</ref><ref name="pmid20630454">Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630454 Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization.] ''JACC Cardiovasc Interv'' 3 (6):612-23. [http://dx.doi.org/10.1016/j.jcin.2010.04.004 DOI:10.1016/j.jcin.2010.04.004] PMID: [http://pubmed.gov/20630454 20630454]</ref><ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID: [http://pubmed.gov/20530001 20530001]</ref><ref name="pmid21697170">Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21697170 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.] ''Eur Heart J'' 32 (17):2125-34. [http://dx.doi.org/10.1093/eurheartj/ehr213 DOI:10.1093/eurheartj/ehr213] PMID: [http://pubmed.gov/21697170 21697170]</ref><ref name="pmid21435606">Capodanno D, Caggegi A, Miano M, Cincotta G, Dipasqua F, Giacchi G et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21435606 Global risk classification and clinical SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score in patients undergoing percutaneous or surgical left main revascularization.] ''JACC Cardiovasc Interv'' 4 (3):287-97. [http://dx.doi.org/10.1016/j.jcin.2010.10.013 DOI:10.1016/j.jcin.2010.10.013] PMID: [http://pubmed.gov/21435606 21435606]</ref><ref name="pmid18216353">Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18216353 Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.] ''N Engl J Med'' 358 (4):331-41. [http://dx.doi.org/10.1056/NEJMoa071804 DOI:10.1056/NEJMoa071804] PMID: [http://pubmed.gov/18216353 18216353]</ref><ref name="pmid9403609">Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9403609 Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.] ''Circulation'' 96 (11):3867-72. PMID: [http://pubmed.gov/9403609 9403609]</ref><ref name="pmid18215597">Biondi-Zoccai GG, Lotrionte M, Moretti C, Meliga E, Agostoni P, Valgimigli M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18215597 A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease.] ''Am Heart J'' 155 (2):274-83. [http://dx.doi.org/10.1016/j.ahj.2007.10.009 DOI:10.1016/j.ahj.2007.10.009] PMID: [http://pubmed.gov/18215597 18215597]</ref><ref name="pmid21272743">Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21272743 Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis.] ''J Am Coll Cardiol'' 57 (5):538-45. [http://dx.doi.org/10.1016/j.jacc.2010.09.038 DOI:10.1016/j.jacc.2010.09.038] PMID: [http://pubmed.gov/21272743 21272743]</ref><ref name="pmid18178401">Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18178401 Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients.] ''Am J Cardiol'' 101 (2):169-72. [http://dx.doi.org/10.1016/j.amjcard.2007.08.054 DOI:10.1016/j.amjcard.2007.08.054] PMID: [http://pubmed.gov/18178401 18178401]</ref><ref name="pmid18237682">Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18237682 Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization.] ''J Am Coll Cardiol'' 51 (5):538-45. [http://dx.doi.org/10.1016/j.jacc.2007.09.054 DOI:10.1016/j.jacc.2007.09.054] PMID: [http://pubmed.gov/18237682 18237682]</ref><ref name="pmid16717151">Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16717151 Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.] ''Circulation'' 113 (21):2542-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595694 DOI:10.1161/CIRCULATIONAHA.105.595694] PMID: [http://pubmed.gov/16717151 16717151]</ref><ref name="pmid16487857">Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16487857 Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.] ''J Am Coll Cardiol'' 47 (4):864-70. [http://dx.doi.org/10.1016/j.jacc.2005.09.072 DOI:10.1016/j.jacc.2005.09.072] PMID: [http://pubmed.gov/16487857 16487857]</ref><ref name="pmid18608116">Mäkikallio TH, Niemelä M, Kervinen K, Jokinen V, Laukkanen J, Ylitalo I et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18608116 Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting.] ''Ann Med'' 40 (6):437-43. [http://dx.doi.org/10.1080/07853890701879790 DOI:10.1080/07853890701879790] PMID: [http://pubmed.gov/18608116 18608116]</ref><ref name="pmid19695542">Naik H, White AJ, Chakravarty T, Forrester J, Fontana G, Kar S et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19695542 A meta-analysis of 3,773 patients treated with percutaneous coronary intervention or surgery for unprotected left main coronary artery stenosis.] ''JACC Cardiovasc Interv'' 2 (8):739-47. [http://dx.doi.org/10.1016/j.jcin.2009.05.020 DOI:10.1016/j.jcin.2009.05.020] PMID: [http://pubmed.gov/19695542 19695542]</ref><ref name="pmid16784920">Palmerini T, Marzocchi A, Marrozzini C, Ortolani P, Saia F, Savini C et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16784920 Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry).] ''Am J Cardiol'' 98 (1):54-9. [http://dx.doi.org/10.1016/j.amjcard.2006.01.070 DOI:10.1016/j.amjcard.2006.01.070] PMID: [http://pubmed.gov/16784920 16784920]</ref><ref name="pmid20451344">Park DW, Seung KB, Kim YH, Lee JY, Kim WJ, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20451344 Long-term safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 5-year results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry.] ''J Am Coll Cardiol'' 56 (2):117-24. [http://dx.doi.org/10.1016/j.jacc.2010.04.004 DOI:10.1016/j.jacc.2010.04.004] PMID: [http://pubmed.gov/20451344 20451344]</ref><ref name="pmid19029471">Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19029471 Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.] ''Circulation'' 118 (23):2374-81. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.727099 DOI:10.1161/CIRCULATIONAHA.107.727099] PMID: [http://pubmed.gov/19029471 19029471]</ref><ref name="pmid17826380">Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17826380 Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease.] ''Am J Cardiol'' 100 (6):970-3. [http://dx.doi.org/10.1016/j.amjcard.2007.04.037 DOI:10.1016/j.amjcard.2007.04.037] PMID: [http://pubmed.gov/17826380 17826380]</ref><ref name="pmid18378517">Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18378517 Stents versus coronary-artery bypass grafting for left main coronary artery disease.] ''N Engl J Med'' 358 (17):1781-92. [http://dx.doi.org/10.1056/NEJMoa0801441 DOI:10.1056/NEJMoa0801441] PMID: [http://pubmed.gov/18378517 18378517]</ref><ref name="pmid19463306">White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19463306 Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis.] ''JACC Cardiovasc Interv'' 1 (3):236-45. [http://dx.doi.org/10.1016/j.jcin.2008.02.007 DOI:10.1016/j.jcin.2008.02.007] PMID: [http://pubmed.gov/19463306 19463306]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]] to improve survival is reasonable in patients with [[UA|UA/NSTEMI]] when an [[PCI in the unprotected left main patient|unprotected left main coronary artery]] is the culprit lesion and the patient is not a candidate for [[Unstable angina / non ST elevation myocardial infarction recommendations for CABG|CABG]]. <ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID: [http://pubmed.gov/20530001 20530001]</ref><ref name="pmid18178401">Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18178401 Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients.] ''Am J Cardiol'' 101 (2):169-72. [http://dx.doi.org/10.1016/j.amjcard.2007.08.054 DOI:10.1016/j.amjcard.2007.08.054] PMID: [http://pubmed.gov/18178401 18178401]</ref><ref name="pmid20630452">Chieffo A, Magni V, Latib A, Maisano F, Ielasi A, Montorfano M et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630452 5-year outcomes following percutaneous coronary intervention with drug-eluting stent implantation versus coronary artery bypass graft for unprotected left main coronary artery lesions the Milan experience.] ''JACC Cardiovasc Interv'' 3 (6):595-601. [http://dx.doi.org/10.1016/j.jcin.2010.03.014 DOI:10.1016/j.jcin.2010.03.014] PMID: [http://pubmed.gov/20630452 20630452]</ref><ref name="pmid16717151">Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16717151 Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.] ''Circulation'' 113 (21):2542-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595694 DOI:10.1161/CIRCULATIONAHA.105.595694] PMID: [http://pubmed.gov/16717151 16717151]</ref><ref name="pmid16487857">Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16487857 Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.] ''J Am Coll Cardiol'' 47 (4):864-70. [http://dx.doi.org/10.1016/j.jacc.2005.09.072 DOI:10.1016/j.jacc.2005.09.072] PMID: [http://pubmed.gov/16487857 16487857]</ref><ref name="pmid19029471">Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19029471 Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.] ''Circulation'' 118 (23):2374-81. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.727099 DOI:10.1161/CIRCULATIONAHA.107.727099] PMID: [http://pubmed.gov/19029471 19029471]</ref><ref name="pmid17826380">Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17826380 Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease.] ''Am J Cardiol'' 100 (6):970-3. [http://dx.doi.org/10.1016/j.amjcard.2007.04.037 DOI:10.1016/j.amjcard.2007.04.037] PMID: [http://pubmed.gov/17826380 17826380]</ref><ref name="pmid18378517">Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18378517 Stents versus coronary-artery bypass grafting for left main coronary artery disease.] ''N Engl J Med'' 358 (17):1781-92. [http://dx.doi.org/10.1056/NEJMoa0801441 DOI:10.1056/NEJMoa0801441] PMID: [http://pubmed.gov/18378517 18378517]</ref><ref name="pmid19463306">White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19463306 Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis.] ''JACC Cardiovasc Interv'' 1 (3):236-45. [http://dx.doi.org/10.1016/j.jcin.2008.02.007 DOI:10.1016/j.jcin.2008.02.007] PMID: [http://pubmed.gov/19463306 19463306]</ref><ref name="pmid19720640">Montalescot G, Brieger D, Eagle KA, Anderson FA, FitzGerald G, Lee MS et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19720640 Unprotected left main revascularization in patients with acute coronary syndromes.] ''Eur Heart J'' 30 (19):2308-17. [http://dx.doi.org/10.1093/eurheartj/ehp353 DOI:10.1093/eurheartj/ehp353] PMID: [http://pubmed.gov/19720640 19720640]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] to improve survival is reasonable in patients with [[STEMI|acute STEMI]] when an [[PCI in the unprotected left main patient|unprotected left main coronary artery]] is the culprit lesion, distal coronary flow is less than TIMI (Thrombolysis In Myocardial Infarction) [[TIMI flow grade|grade 3]], and [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] can be performed more rapidly and safely than [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. <ref name="pmid9403609">Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9403609 Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.] ''Circulation'' 96 (11):3867-72. PMID: [http://pubmed.gov/9403609 9403609]</ref><ref name="pmid18573394">Lee MS, Tseng CH, Barker CM, Menon V, Steckman D, Shemin R et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18573394 Outcome after surgery and percutaneous intervention for cardiogenic shock and left main disease.] ''Ann Thorac Surg'' 86 (1):29-34. [http://dx.doi.org/10.1016/j.athoracsur.2008.03.019 DOI:10.1016/j.athoracsur.2008.03.019] PMID: [http://pubmed.gov/18573394 18573394]</ref><ref name="pmid20723848">Lee MS, Bokhoor P, Park SJ, Kim YH, Stone GW, Sheiban I et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20723848 Unprotected left main coronary disease and ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention.] ''JACC Cardiovasc Interv'' 3 (8):791-5. [http://dx.doi.org/10.1016/j.jcin.2010.06.005 DOI:10.1016/j.jcin.2010.06.005] PMID: [http://pubmed.gov/20723848 20723848]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve survival may be reasonable as an alternative to [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] in selected [[chronic stable angina definition|stable]] patients with significant (greater than or equal to 50% diameter [[stenosis]]) [[PCI in the unprotected left main patient|unprotected left main CAD]] with:
 
:'''a.''' Anatomic conditions associated with a low to intermediate risk of [[Chronic stable angina revascularization complications of percutaneous coronary intervention|PCI procedural complications]] and an intermediate to high likelihood of good long-term outcome (e.g., low-intermediate [[SYNTAX|SYNTAX score]] of lower than 33, bifurcation [[left main]] [[CAD]]); and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' Clinical characteristics that predict an increased risk of adverse surgical outcomes (e.g., moderate-severe [[COPD|chronic obstructive pulmonary disease]], [[Stroke rehabilitation|disability from previous stroke]], or previous cardiac surgery; Society of Thoracic Surgeons–predicted risk of operative mortality greater than 2%). <ref name="pmid21256999">Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21256999 Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization.] ''Am J Cardiol'' 107 (3):360-6. [http://dx.doi.org/10.1016/j.amjcard.2010.09.029 DOI:10.1016/j.amjcard.2010.09.029] PMID: [http://pubmed.gov/21256999 21256999]</ref><ref name="pmid20630454">Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630454 Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization.] ''JACC Cardiovasc Interv'' 3 (6):612-23. [http://dx.doi.org/10.1016/j.jcin.2010.04.004 DOI:10.1016/j.jcin.2010.04.004] PMID: [http://pubmed.gov/20630454 20630454]</ref><ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID: [http://pubmed.gov/20530001 20530001]</ref><ref name="pmid21697170">Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21697170 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.] ''Eur Heart J'' 32 (17):2125-34. [http://dx.doi.org/10.1093/eurheartj/ehr213DOI:10.1093/eurheartj/ehr213] PMID: [http://pubmed.gov/21697170 21697170]</ref><ref name="pmid21435606">Capodanno D, Caggegi A, Miano M, Cincotta G, Dipasqua F, Giacchi G et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21435606 Global risk classification and clinical SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score in patients undergoing percutaneous or surgical left main revascularization.] ''JACC Cardiovasc Interv'' 4 (3):287-97. [http://dx.doi.org/10.1016/j.jcin.2010.10.013 DOI:10.1016/j.jcin.2010.10.013] PMID: [http://pubmed.gov/21435606 21435606]</ref><ref name="pmid18216353">Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18216353 Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.] ''N Engl J Med'' 358 (4):331-41. [http://dx.doi.org/10.1056/NEJMoa071804 DOI:10.1056/NEJMoa071804] PMID: [http://pubmed.gov/18216353 18216353]</ref><ref name="pmid9403609">Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9403609 Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996.] ''Circulation'' 96 (11):3867-72. PMID: [http://pubmed.gov/9403609 9403609]</ref><ref name="pmid18215597">Biondi-Zoccai GG, Lotrionte M, Moretti C, Meliga E, Agostoni P, Valgimigli M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18215597 A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease.] ''Am Heart J'' 155 (2):274-83. [http://dx.doi.org/10.1016/j.ahj.2007.10.009 DOI:10.1016/j.ahj.2007.10.009] PMID: [http://pubmed.gov/18215597 18215597]</ref><ref name="pmid21272743">Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21272743 Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis.] ''J Am Coll Cardiol'' 57 (5):538-45. [http://dx.doi.org/10.1016/j.jacc.2010.09.038 DOI:10.1016/j.jacc.2010.09.038] PMID: [http://pubmed.gov/21272743 21272743]</ref><ref name="pmid18178401">Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18178401 Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients.] ''Am J Cardiol'' 101 (2):169-72. [http://dx.doi.org/10.1016/j.amjcard.2007.08.054 DOI:10.1016/j.amjcard.2007.08.054] PMID: [http://pubmed.gov/18178401 18178401]</ref><ref name="pmid18237682">Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18237682 Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization.] ''J Am Coll Cardiol'' 51 (5):538-45. [http://dx.doi.org/10.1016/j.jacc.2007.09.054 DOI:10.1016/j.jacc.2007.09.054] PMID: [http://pubmed.gov/18237682 18237682]</ref><ref name="pmid16717151">Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16717151 Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience.] ''Circulation'' 113 (21):2542-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595694 DOI:10.1161/CIRCULATIONAHA.105.595694] PMID: [http://pubmed.gov/16717151 16717151]</ref><ref name="pmid16487857">Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16487857 Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.] ''J Am Coll Cardiol'' 47 (4):864-70. [http://dx.doi.org/10.1016/j.jacc.2005.09.072 DOI:10.1016/j.jacc.2005.09.072] PMID: [http://pubmed.gov/16487857 16487857]</ref><ref name="pmid18608116">Mäkikallio TH, Niemelä M, Kervinen K, Jokinen V, Laukkanen J, Ylitalo I et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18608116 Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting.] ''Ann Med'' 40 (6):437-43. [http://dx.doi.org/10.1080/07853890701879790 DOI:10.1080/07853890701879790] PMID: [http://pubmed.gov/18608116 18608116]</ref><ref name="pmid19695542">Naik H, White AJ, Chakravarty T, Forrester J, Fontana G, Kar S et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19695542 A meta-analysis of 3,773 patients treated with percutaneous coronary intervention or surgery for unprotected left main coronary artery stenosis.] ''JACC Cardiovasc Interv'' 2 (8):739-47. [http://dx.doi.org/10.1016/j.jcin.2009.05.020 DOI:10.1016/j.jcin.2009.05.020] PMID: [http://pubmed.gov/19695542 19695542]</ref><ref name="pmid16784920">Palmerini T, Marzocchi A, Marrozzini C, Ortolani P, Saia F, Savini C et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16784920 Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry).] ''Am J Cardiol'' 98 (1):54-9. [http://dx.doi.org/10.1016/j.amjcard.2006.01.070 DOI:10.1016/j.amjcard.2006.01.070] PMID: [http://pubmed.gov/16784920 16784920]</ref><ref name="pmid20451344">Park DW, Seung KB, Kim YH, Lee JY, Kim WJ, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20451344 Long-term safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 5-year results from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry.] ''J Am Coll Cardiol'' 56 (2):117-24. [http://dx.doi.org/10.1016/j.jacc.2010.04.004 DOI:10.1016/j.jacc.2010.04.004] PMID: [http://pubmed.gov/20451344 20451344]</ref><ref name="pmid19029471">Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19029471 Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.] ''Circulation'' 118 (23):2374-81. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.727099 DOI:10.1161/CIRCULATIONAHA.107.727099] PMID: [http://pubmed.gov/19029471 19029471]</ref><ref name="pmid17826380">Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17826380 Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease.] ''Am J Cardiol'' 100 (6):970-3. [http://dx.doi.org/10.1016/j.amjcard.2007.04.037 DOI:10.1016/j.amjcard.2007.04.037] PMID: [http://pubmed.gov/17826380 17826380]</ref><ref name="pmid18378517">Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18378517 Stents versus coronary-artery bypass grafting for left main coronary artery disease.] ''N Engl J Med'' 358 (17):1781-92. [http://dx.doi.org/10.1056/NEJMoa0801441 DOI:10.1056/NEJMoa0801441] PMID: [http://pubmed.gov/18378517 18378517]</ref><ref name="pmid19463306">White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19463306 Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis.] ''JACC Cardiovasc Interv'' 1 (3):236-45. [http://dx.doi.org/10.1016/j.jcin.2008.02.007 DOI:10.1016/j.jcin.2008.02.007] PMID: [http://pubmed.gov/19463306 19463306]</ref><ref name="pmid21463149">Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21463149 Randomized trial of stents versus bypass surgery for left main coronary artery disease.] ''N Engl J Med'' 364 (18):1718-27.[http://dx.doi.org/10.1056/NEJMoa1100452 DOI:10.1056/NEJMoa1100452] PMID: [http://pubmed.gov/2146314921463149]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve survival should not be performed in [[chronic stable angina definition|stable]] patients with significant (greater than or equal to 50% diameter [[stenosis]]) [[PCI in the unprotected left main patient|unprotected left main CAD]] who have unfavorable anatomy for [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] and who are good candidates for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. <ref name="pmid21256999">Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21256999 Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization.] ''Am J Cardiol'' 107 (3):360-6. [http://dx.doi.org/10.1016/j.amjcard.2010.09.029 DOI:10.1016/j.amjcard.2010.09.029] PMID: [http://pubmed.gov/21256999 21256999]</ref><ref name="pmid20630454">Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20630454 Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization.] ''JACC Cardiovasc Interv'' 3 (6):612-23. [http://dx.doi.org/10.1016/j.jcin.2010.04.004 DOI:10.1016/j.jcin.2010.04.004] PMID: [http://pubmed.gov/20630454 20630454]</ref><ref name="pmid20530001">Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20530001 Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial.] ''Circulation'' 121 (24):2645-53. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.899211 DOI:10.1161/CIRCULATIONAHA.109.899211] PMID: [http://pubmed.gov/20530001 20530001]</ref><ref name="pmid7729018">Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7729018 Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience.] ''Circulation'' 91 (9):2325-34. PMID: [http://pubmed.gov/7729018 7729018]</ref><ref name="pmid7025604">Chaitman BR, Fisher LD, Bourassa MG, Davis K, Rogers WJ, Maynard C et al. (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7025604 Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS).] ''Am J Cardiol'' 48 (4):765-77. PMID: [http://pubmed.gov/7025604 7025604]</ref><ref name="pmid11431667">Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11431667 Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators.] ''Am Heart J'' 142 (1):119-26. [http://dx.doi.org/10.1067/mhj.2001.116072 DOI:10.1067/mhj.2001.116072] PMID: [http://pubmed.gov/11431667 11431667]</ref><ref name="pmid791537">Takaro T, Hultgren HN, Lipton MJ, Detre KM (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=791537 The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions.] ''Circulation'' 54 (6 Suppl):III107-17. PMID: [http://pubmed.gov/791537 791537]</ref><ref name="pmid6979435">Takaro T, Peduzzi P, Detre KM, Hultgren HN, Murphy ML, van der Bel-Kahn J et al. (1982) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6979435 Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease.] ''Circulation'' 66 (1):14-22. PMID: [http://pubmed.gov/6979435 6979435]</ref><ref name="pmid2785870">Taylor HA, Deumite NJ, Chaitman BR, Davis KB, Killip T, Rogers WJ (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2785870 Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry.] ''Circulation'' 79 (6):1171-9. PMID: [http://pubmed.gov/2785870 2785870]</ref><ref name="pmid7914958">Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW et al. (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7914958 Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration.] ''Lancet'' 344 (8922):563-70. PMID: [http://pubmed.gov/7914958 7914958]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Revascularization to Improve Survival: Non-Left Main Coronary Artery Disease <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' [[CABG]] to improve survival is beneficial in patients with significant (greater than or equal to 70% diameter) [[stenoses]] in 3 major coronary arteries (with or without involvement of the [[LAD|proximal left anterior descending]] [[LAD]]) or in the proximal LAD plus 1 other major coronary artery. <ref name="pmid11431667">{{cite journal |author=Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD, Galbraith PD, Hui W, Faris P, Knudtson ML |title=Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators |journal=[[American Heart Journal]] |volume=142 |issue=1 |pages=119–26 |year=2001 |month=July |pmid=11431667 |doi=10.1067/mhj.2001.116072 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(01)66057-5 |accessdate=2011-12-04}}</ref><ref name="pmid7914958">{{cite journal |author=Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R |title=Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration |journal=[[Lancet]] |volume=344 |issue=8922 |pages=563–70 |year=1994 |month=August |pmid=7914958 |doi= |url= |accessdate=2011-12-04}}</ref><ref name="pmid8622299">{{cite journal |author=Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM |title=Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=111 |issue=5 |pages=1013–25 |year=1996 |month=May |pmid=8622299 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(96)70378-1 |accessdate=2011-12-04}}</ref><ref name="pmid2648078">{{cite journal |author=Myers WO, Schaff HV, Gersh BJ, Fisher LD, Kosinski AS, Mock MB, Holmes DR, Ryan TJ, Kaiser GC |title=Improved survival of surgically treated patients with triple vessel coronary artery disease and severe angina pectoris. A report from the Coronary Artery Surgery Study (CASS) registry |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=97 |issue=4 |pages=487–95 |year=1989 |month=April |pmid=2648078 |doi= |url= |accessdate=2011-12-04}}</ref><ref name="pmid3260659">{{cite journal |author=Varnauskas E |title=Twelve-year follow-up of survival in the randomized European Coronary Surgery Study |journal=[[The New England Journal of Medicine]] |volume=319 |issue=6 |pages=332–7 |year=1988 |month=August |pmid=3260659 |doi=10.1056/NEJM198808113190603 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198808113190603?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2011-12-04}}</ref><ref name="pmid16996946">{{cite journal |author=Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH |title=Selection of surgical or percutaneous coronary intervention provides differential longevity benefit |journal=[[The Annals of Thoracic Surgery]] |volume=82 |issue=4 |pages=1420–8; discussion 1428–9 |year=2006 |month=October |pmid=16996946 |doi=10.1016/j.athoracsur.2006.04.044 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00829-0 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[CABG]] or PCI to improve survival is beneficial in survivors of [[sudden cardiac death]] with presumed [[ischemia]]-mediated [[ventricular tachycardia]] caused by significant (greater than or equal to 70% diameter) [[stenosis]] in a major coronary artery. ([[CABG]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <ref name="pmid12667561">{{cite journal |author=Borger van der Burg AE, Bax JJ, Boersma E, Bootsma M, van Erven L, van der Wall EE, Schalij MJ |title=Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital |journal=[[The American Journal of Cardiology]] |volume=91 |issue=7 |pages=785–9 |year=2003 |month=April |pmid=12667561 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914903000080 |accessdate=2011-12-04}}</ref><ref name="pmid1593036">{{cite journal |author=Every NR, Fahrenbruch CE, Hallstrom AP, Weaver WD, Cobb LA |title=Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest |journal=[[Journal of the American College of Cardiology]] |volume=19 |issue=7 |pages=1435–9 |year=1992 |month=June |pmid=1593036 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0735-1097(92)90599-I |accessdate=2011-12-04}}</ref><ref name="pmid1081278">{{cite journal |author=Kaiser GA, Ghahramani A, Bolooki H, Vargas A, Thurer RJ, Williams WH, Myerburg RJ |title=Role of coronary artery surgery in patients surviving unexpected cardiac arrest |journal=[[Surgery]] |volume=78 |issue=6 |pages=749–54 |year=1975 |month=December |pmid=1081278 |doi= |url= |accessdate=2011-12-04}}</ref>; PCI ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <ref name="pmid12667561">{{cite journal |author=Borger van der Burg AE, Bax JJ, Boersma E, Bootsma M, van Erven L, van der Wall EE, Schalij MJ |title=Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital |journal=[[The American Journal of Cardiology]] |volume=91 |issue=7 |pages=785–9 |year=2003 |month=April |pmid=12667561 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914903000080 |accessdate=2011-12-04}}</ref>)
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[CABG]] to improve survival is reasonable in patients with significant (greater than or equal to 70% diameter) stenoses in 2 major coronary arteries with severe or extensive [[myocardial ischemia]] (e.g., high-risk criteria on [[Exercise stress testing|stress testing]], abnormal intra-coronary hemodynamic evaluation, or greater than 20% perfusion defect by [[Stress Radionuclide Myocardial Perfusion Imaging|myocardial perfusion stress imaging]]) or target vessels supplying a large area of viable [[myocardium]]. <ref name="pmid9832692">{{cite journal |author=Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, Fromm B |title=Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=116 |issue=6 |pages=997–1004 |year=1998 |month=December |pmid=9832692 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522398004759 |accessdate=2011-12-04}}</ref><ref name="pmid12771008">{{cite journal |author=Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS |title=Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography |journal=[[Circulation]] |volume=107 |issue=23 |pages=2900–7 |year=2003 |month=June |pmid=12771008 |doi=10.1161/01.CIR.0000072790.23090.41 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12771008 |accessdate=2011-12-04}}</ref><ref name="pmid16159837">{{cite journal |author=Sorajja P, Chareonthaitawee P, Rajagopalan N, Miller TD, Frye RL, Hodge DO, Gibbons RJ |title=Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting |journal=[[Circulation]] |volume=112 |issue=9 Suppl |pages=I311–6 |year=2005 |month=August |pmid=16159837 |doi=10.1161/CIRCULATIONAHA.104.525022 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16159837 |accessdate=2011-12-04}}</ref><ref name="pmid9133513">{{cite journal |author=Davies RF, Goldberg AD, Forman S, Pepine CJ, Knatterud GL, Geller N, Sopko G, Pratt C, Deanfield J, Conti CR |title=Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: outcomes of patients randomized to initial strategies of medical therapy versus revascularization |journal=[[Circulation]] |volume=95 |issue=8 |pages=2037–43 |year=1997 |month=April |pmid=9133513 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9133513 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[CABG]] to improve survival is reasonable in patients with mild-moderate [[systolic dysfunction|left ventricular systolic dysfunction]] ([[ejection fraction]] 35% to 50%) and significant (greater than or equal to 70% diameter [[stenosis]]) [[CAD|multivessel CAD]] or [[LAD|proximal LAD]] coronary artery stenosis, when viable myocardium is present in the region of intended [[revascularization]]. <ref name="pmid7914958">{{cite journal |author=Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R |title=Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration |journal=[[Lancet]] |volume=344 |issue=8922 |pages=563–70 |year=1994 |month=August |pmid=7914958 |doi= |url= |accessdate=2011-12-04}}</ref><ref name="pmid6352078">{{cite journal |author=Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, Levine F, Schloss M |title=Results of coronary artery surgery in patients with poor left ventricular function (CASS) |journal=[[Circulation]] |volume=68 |issue=4 |pages=785–95 |year=1983 |month=October |pmid=6352078 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=6352078 |accessdate=2011-12-04}}</ref><ref name="pmid12106836">{{cite journal |author=O'Connor CM, Velazquez EJ, Gardner LH, Smith PK, Newman MF, Landolfo KP, Lee KL, Califf RM, Jones RH |title=Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank) |journal=[[The American Journal of Cardiology]] |volume=90 |issue=2 |pages=101–7 |year=2002 |month=July |pmid=12106836 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914902024293 |accessdate=2011-12-04}}</ref><ref name="pmid17394905">{{cite journal |author=Phillips HR, O'Connor CM, Rogers J |title=Revascularization for heart failure |journal=[[American Heart Journal]] |volume=153 |issue=4 Suppl |pages=65–73 |year=2007 |month=April |pmid=17394905 |doi=10.1016/j.ahj.2007.01.026 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00085-3 |accessdate=2011-12-04}}</ref><ref name="pmid16391157">{{cite journal |author=Tarakji KG, Brunken R, McCarthy PM, Al-Chekakie MO, Abdel-Latif A, Pothier CE, Blackstone EH, Lauer MS |title=Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction |journal=[[Circulation]] |volume=113 |issue=2 |pages=230–7 |year=2006 |month=January |pmid=16391157 |doi=10.1161/CIRCULATIONAHA.105.541664 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16391157 |accessdate=2011-12-04}}</ref><ref name="pmid16908896">{{cite journal |author=Tsuyuki RT, Shrive FM, Galbraith PD, Knudtson ML, Graham MM |title=Revascularization in patients with heart failure |journal=[[CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne]] |volume=175 |issue=4 |pages=361–5 |year=2006 |month=August |pmid=16908896 |pmc=1534111 |doi=10.1503/cmaj.060108 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16908896 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[CABG]] with a [[LIMA|left internal mammary artery graft]] to improve survival is reasonable in patients with significant (greater than or equal to 70% diameter) stenosis in the [[LAD|proximal LAD artery]] and evidence of extensive [[ischemia]]. <ref name="pmid7914958">{{cite journal |author=Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R |title=Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration |journal=[[Lancet]] |volume=344 |issue=8922 |pages=563–70 |year=1994 |month=August |pmid=7914958 |doi= |url= |accessdate=2011-12-04}}</ref><ref name="pmid16996946">{{cite journal |author=Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH |title=Selection of surgical or percutaneous coronary intervention provides differential longevity benefit |journal=[[The Annals of Thoracic Surgery]] |volume=82 |issue=4 |pages=1420–8; discussion 1428–9 |year=2006 |month=October |pmid=16996946 |doi=10.1016/j.athoracsur.2006.04.044 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00829-0 |accessdate=2011-12-04}}</ref><ref name="pmid8531997">{{cite journal |author=Cameron A, Davis KB, Green G, Schaff HV |title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period |journal=[[The New England Journal of Medicine]] |volume=334 |issue=4 |pages=216–9 |year=1996 |month=January |pmid=8531997 |doi=10.1056/NEJM199601253340402 |url=http://dx.doi.org/10.1056/NEJM199601253340402 |accessdate=2011-12-04}}</ref><ref name="pmid3484393">{{cite journal |author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC |title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events |journal=[[The New England Journal of Medicine]] |volume=314 |issue=1 |pages=1–6 |year=1986 |month=January |pmid=3484393 |doi=10.1056/NEJM198601023140101 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198601023140101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''4.''' It is reasonable to choose [[CABG]] over PCI to improve survival in patients with complex [[CAD|3-vessel CAD]] (e.g., [[SYNTAX|SYNTAX score]] greater than 22) with or without involvement of the [[LAD|proximal LAD]] artery who are good candidates for [[CABG]]. <ref name="pmid16996946">{{cite journal |author=Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH |title=Selection of surgical or percutaneous coronary intervention provides differential longevity benefit|journal=[[The Annals of Thoracic Surgery]] |volume=82 |issue=4 |pages=1420–8; discussion 1428–9 |year=2006 |month=October |pmid=16996946|doi=10.1016/j.athoracsur.2006.04.044 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00829-0 |accessdate=2011-12-04}}</ref><ref name="pmid15117846">{{cite journal |author=Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS|title=Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features |journal=[[Circulation]] |volume=109 |issue=19 |pages=2290–5 |year=2004 |month=May |pmid=15117846|doi=10.1161/01.CIR.0000126826.58526.14 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15117846 |accessdate=2011-12-04}}</ref><ref name="pmid18216353">{{cite journal |author=Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH |title=Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease |journal=[[The New England Journal of Medicine]] |volume=358 |issue=4 |pages=331–41 |year=2008 |month=January |pmid=18216353 |doi=10.1056/NEJMoa071804 |url=http://dx.doi.org/10.1056/NEJMoa071804 |accessdate=2011-12-04}}</ref><ref name="pmid21697170">{{cite journal |author=Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A |title=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 |journal=[[European Heart Journal]] |volume=32 |issue=17 |pages=2125–34 |year=2011 |month=September |pmid=21697170 |doi=10.1093/eurheartj/ehr213 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21697170 |accessdate=2011-12-04}}</ref><ref name="pmid15917382">{{cite journal |author=Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA |title=Long-term outcomes of coronary-artery bypass grafting versus stent implantation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=21 |pages=2174–83 |year=2005 |month=May |pmid=15917382 |doi=10.1056/NEJMoa040316 |url=http://dx.doi.org/10.1056/NEJMoa040316 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''5.''' [[CABG]] is probably recommended in preference to PCI to improve survival in patients with [[CAD|multivessel CAD]] and [[diabetes mellitus]], particularly if a [[LIMA|left internal mammary artery graft]] can be anastomosed to the [[LAD|LAD artery]]. <ref name="pmid16159837">{{cite journal |author=Sorajja P, Chareonthaitawee P, Rajagopalan N, Miller TD, Frye RL, Hodge DO, Gibbons RJ |title=Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting |journal=[[Circulation]] |volume=112 |issue=9 Suppl |pages=I311–6 |year=2005 |month=August |pmid=16159837 |doi=10.1161/CIRCULATIONAHA.104.525022 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16159837 |accessdate=2011-12-04}}</ref><ref name="pmid9323059">{{cite journal |author= |title=Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI) |journal=[[Circulation]] |volume=96 |issue=6 |pages=1761–9 |year=1997 |month=September |pmid=9323059 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9323059 |accessdate=2011-12-04}}</ref><ref name="pmid17433949">{{cite journal |author= |title=The final 10-year follow-up results from the BARI randomized trial |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=15 |pages=1600–6 |year=2007 |month=April |pmid=17433949 |doi=10.1016/j.jacc.2006.11.048 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00432-9 |accessdate=2011-12-04}}</ref><ref name="pmid20079596">{{cite journal |author=Banning AP, Westaby S, Morice MC, Kappetein AP, Mohr FW, Berti S, Glauber M, Kellett MA, Kramer RS, Leadley K, Dawkins KD, Serruys PW |title=Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents |journal=[[Journal of the American College of Cardiology]] |volume=55 |issue=11 |pages=1067–75 |year=2010 |month=March |pmid=20079596 |doi=10.1016/j.jacc.2009.09.057 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)04074-1 |accessdate=2011-12-04}}</ref><ref name="pmid15917382">{{cite journal |author=Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA |title=Long-term outcomes of coronary-artery bypass grafting versus stent implantation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=21 |pages=2174–83 |year=2005 |month=May |pmid=15917382 |doi=10.1056/NEJMoa040316 |url=http://dx.doi.org/10.1056/NEJMoa040316 |accessdate=2011-12-04}}</ref><ref name="pmid17339566">{{cite journal |author=Hueb W, Lopes NH, Gersh BJ, Soares P, Machado LA, Jatene FB, Oliveira SA, Ramires JA |title=Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease |journal=[[Circulation]] |volume=115 |issue=9 |pages=1082–9 |year=2007 |month=March |pmid=17339566 |doi=10.1161/CIRCULATIONAHA.106.625475 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17339566 |accessdate=2011-12-04}}</ref><ref name="pmid16159849">{{cite journal |author=Malenka DJ, Leavitt BJ, Hearne MJ, Robb JF, Baribeau YR, Ryan TJ, Helm RE, Kellett MA, Dauerman HL, Dacey LJ, Silver MT, VerLee PN, Weldner PW, Hettleman BD, Olmstead EM, Piper WD, O'Connor GT |title=Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England |journal=[[Circulation]] |volume=112 |issue=9 Suppl |pages=I371–6 |year=2005 |month=August |pmid=16159849 |doi=10.1161/CIRCULATIONAHA.104.526392 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16159849 |accessdate=2011-12-04}}</ref><ref name="pmid11263600">{{cite journal |author=Niles NW, McGrath PD, Malenka D, Quinton H, Wennberg D, Shubrooks SJ, Tryzelaar JF, Clough R, Hearne MJ, Hernandez F, Watkins MW, O'Connor GT |title=Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. Northern New England Cardiovascular Disease Study Group |journal=[[Journal of the American College of Cardiology]] |volume=37 |issue=4 |pages=1008–15 |year=2001 |month=March |pmid=11263600 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109700012055 |accessdate=2011-12-04}}</ref><ref name="pmid9426011">{{cite journal |author=Weintraub WS, Stein B, Kosinski A, Douglas JS, Ghazzal ZM, Jones EL, Morris DC, Guyton RA, Craver JM, King SB |title=Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease |journal=[[Journal of the American College of Cardiology]] |volume=31 |issue=1 |pages=10–9 |year=1998 |month=January |pmid=9426011 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(97)00441-5 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' The usefulness of [[CABG]] to improve survival is uncertain in patients with significant (greater than or equal to 70%) stenoses in 2 major coronary arteries not involving the [[LAD|proximal LAD artery]] and without extensive [[ischemia]]. <ref name="pmid16996946">{{cite journal |author=Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH |title=Selection of surgical or percutaneous coronary intervention provides differential longevity benefit |journal=[[The Annals of Thoracic Surgery]] |volume=82 |issue=4 |pages=1420–8; discussion 1428–9 |year=2006 |month=October |pmid=16996946 |doi=10.1016/j.athoracsur.2006.04.044 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00829-0 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' The usefulness of PCI to improve survival is uncertain in patients with [[CAD|2- or 3-vessel CAD]] (with or without involvement of the [[LAD|proximal LAD artery]]) or [[LAD|1-vessel proximal LAD]] [[CAD|disease]]. <ref name="pmid11431667">{{cite journal |author=Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD, Galbraith PD, Hui W, Faris P, Knudtson ML |title=Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators |journal=[[American Heart Journal]] |volume=142 |issue=1 |pages=119–26 |year=2001 |month=July |pmid=11431667 |doi=10.1067/mhj.2001.116072 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(01)66057-5 |accessdate=2011-12-04}}</ref><ref name="pmid8622299">{{cite journal |author=Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM |title=Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=111 |issue=5 |pages=1013–25 |year=1996 |month=May |pmid=8622299 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(96)70378-1 |accessdate=2011-12-04}}</ref><ref name="pmid16996946">{{cite journal |author=Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH |title=Selection of surgical or percutaneous coronary intervention provides differential longevity benefit |journal=[[The Annals of Thoracic Surgery]] |volume=82 |issue=4 |pages=1420–8; discussion 1428–9 |year=2006 |month=October |pmid=16996946 |doi=10.1016/j.athoracsur.2006.04.044 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00829-0 |accessdate=2011-12-04}}</ref><ref name="pmid17387127">{{cite journal |author=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 |title=Optimal medical therapy with or without PCI for stable coronary disease |journal=[[The New England Journal of Medicine]] |volume=356 |issue=15 |pages=1503–16 |year=2007 |month=April |pmid=17387127 |doi=10.1056/NEJMoa070829 |url=http://dx.doi.org/10.1056/NEJMoa070829 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[CABG]] might be considered with the primary or sole intent of improving survival in patients with [[chronic stable angina definition|stable ischemic heart disease]] with severe left ventricular [[systolic dysfunction]] ([[ejection fraction]] less than 35%) whether or not viable myocardium is present. <ref name="pmid7914958">{{cite journal |author=Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R |title=Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration |journal=[[Lancet]] |volume=344 |issue=8922 |pages=563–70 |year=1994 |month=August |pmid=7914958 |doi= |url= |accessdate=2011-12-04}}</ref><ref name="pmid6352078">{{cite journal |author=Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, Levine F, Schloss M |title=Results of coronary artery surgery in patients with poor left ventricular function (CASS) |journal=[[Circulation]] |volume=68 |issue=4 |pages=785–95 |year=1983 |month=October |pmid=6352078 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=6352078 |accessdate=2011-12-04}}</ref><ref name="pmid12106836">{{cite journal |author=O'Connor CM, Velazquez EJ, Gardner LH, Smith PK, Newman MF, Landolfo KP, Lee KL, Califf RM, Jones RH |title=Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank) |journal=[[The American Journal of Cardiology]] |volume=90 |issue=2 |pages=101–7 |year=2002 |month=July |pmid=12106836 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914902024293 |accessdate=2011-12-04}}</ref><ref name="pmid17394905">{{cite journal |author=Phillips HR, O'Connor CM, Rogers J |title=Revascularization for heart failure |journal=[[American Heart Journal]] |volume=153 |issue=4 Suppl |pages=65–73 |year=2007 |month=April |pmid=17394905 |doi=10.1016/j.ahj.2007.01.026 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00085-3 |accessdate=2011-12-04}}</ref><ref name="pmid16391157">{{cite journal |author=Tarakji KG, Brunken R, McCarthy PM, Al-Chekakie MO, Abdel-Latif A, Pothier CE, Blackstone EH, Lauer MS |title=Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction |journal=[[Circulation]] |volume=113 |issue=2 |pages=230–7 |year=2006 |month=January |pmid=16391157 |doi=10.1161/CIRCULATIONAHA.105.541664 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16391157 |accessdate=2011-12-04}}</ref><ref name="pmid16908896">{{cite journal |author=Tsuyuki RT, Shrive FM, Galbraith PD, Knudtson ML, Graham MM |title=Revascularization in patients with heart failure |journal=[[CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne]] |volume=175 |issue=4 |pages=361–5 |year=2006 |month=August |pmid=16908896 |pmc=1534111 |doi=10.1503/cmaj.060108 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16908896 |accessdate=2011-12-04}}</ref><ref name="pmid21463153">{{cite journal |author=Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P, Drozdz J, Farsky PS, Feldman AM, Doenst T, Michler RE, Berman DS, Nicolau JC, Pellikka PA, Wrobel K, Alotti N, Asch FM, Favaloro LE, She L, Velazquez EJ, Jones RH, Panza JA |title=Myocardial viability and survival in ischemic left ventricular dysfunction |journal=[[The New England Journal of Medicine]] |volume=364 |issue=17 |pages=1617–25 |year=2011 |month=April |pmid=21463153 |doi=10.1056/NEJMoa1100358 |url=http://dx.doi.org/10.1056/NEJMoa1100358 |accessdate=2011-12-04}}</ref><ref name="pmid21463150">{{cite journal |author=Velazquez EJ, Lee KL, Deja MA, Jain A, Sopko G, Marchenko A, Ali IS, Pohost G, Gradinac S, Abraham WT, Yii M, Prabhakaran D, Szwed H, Ferrazzi P, Petrie MC, O'Connor CM, Panchavinnin P, She L, Bonow RO, Rankin GR, Jones RH, Rouleau JL |title=Coronary-artery bypass surgery in patients with left ventricular dysfunction |journal=[[The New England Journal of Medicine]] |volume=364 |issue=17 |pages=1607–16 |year=2011 |month=April |pmid=21463150 |doi=10.1056/NEJMoa1100356 |url=http://dx.doi.org/10.1056/NEJMoa1100356 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''4.''' The usefulness of [[CABG]] or PCI to improve survival is uncertain in patients with previous [[CABG]] and extensive anterior wall [[ischemia]] on noninvasive testing. <ref name="pmid16272211">{{cite journal |author=Brener SJ, Lytle BW, Casserly IP, Ellis SG, Topol EJ, Lauer MS |title=Predictors of revascularization method and long-term outcome of percutaneous coronary intervention or repeat coronary bypass surgery in patients with multivessel coronary disease and previous coronary bypass surgery |journal=[[European Heart Journal]] |volume=27 |issue=4 |pages=413–8 |year=2006 |month=February |pmid=16272211 |doi=10.1093/eurheartj/ehi646 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16272211 |accessdate=2011-12-04}}</ref><ref name="pmid17045681">{{cite journal |author=Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA |title=Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery |journal=[[International Journal of Cardiology]] |volume=119 |issue=1 |pages=65–72 |year=2007 |month=June |pmid=17045681 |doi=10.1016/j.ijcard.2006.07.058 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00905-3 |accessdate=2011-12-04}}</ref><ref name="pmid8468995">{{cite journal |author=Lytle BW, Loop FD, Taylor PC, Goormastic M, Stewart RW, Novoa R, McCarthy P, Cosgrove DM |title=The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=105 |issue=4 |pages=605–12; discussion 612–4 |year=1993 |month=April |pmid=8468995 |doi= |url= |accessdate=2011-12-04}}</ref><ref name="pmid11451264">{{cite journal |author=Morrison DA, Sethi G, Sacks J, Henderson W, Grover F, Sedlis S, Esposito R, Ramanathan K, Weiman D, Saucedo J, Antakli T, Paramesh V, Pett S, Vernon S, Birjiniuk V, Welt F, Krucoff M, Wolfe W, Lucke JC, Mediratta S, Booth D, Barbiere C, Lewis D |title=Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. Investigators of the Department of Veterans Affairs Cooperative Study #385, the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) |journal=[[Journal of the American College of Cardiology]] |volume=38 |issue=1 |pages=143–9 |year=2001 |month=July |pmid=11451264 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109701013663 |accessdate=2011-12-04}}</ref><ref name="pmid10467648">{{cite journal |author=Pfautsch P, Frantz E, Ellmer A, Sauer HU, Fleck E |title=[Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization] |language=German |journal=[[Zeitschrift Für Kardiologie]] |volume=88 |issue=7 |pages=489–97 |year=1999 |month=July |pmid=10467648 |doi= |url=http://link.springer.de/link/service/journals/00392/bibs/9088007/90880489.htm |accessdate=2011-12-04}}</ref><ref name="pmid9860204">{{cite journal |author=Sergeant P, Blackstone E, Meyns B, Stockman B, Jashari R |title=First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting |journal=[[European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery]] |volume=14 |issue=5 |pages=480–7 |year=1998 |month=November |pmid=9860204 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1010794098002140 |accessdate=2011-12-04}}</ref><ref name="pmid8890807">{{cite journal |author=Stephan WJ, O'Keefe JH, Piehler JM, McCallister BD, Dahiya RS, Shimshak TM, Ligon RW, Hartzler GO |title=Coronary angioplasty versus repeat coronary artery bypass grafting for patients with previous bypass surgery |journal=[[Journal of the American College of Cardiology]] |volume=28 |issue=5 |pages=1140–6 |year=1996 |month=November |pmid=8890807 |doi=10.1016/S0735-1097(96)00286-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(96)00286-0 |accessdate=2011-12-04}}</ref><ref name="pmid19379872">{{cite journal |author=Subramanian S, Sabik JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW |title=Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending |journal=[[The Annals of Thoracic Surgery]] |volume=87 |issue=5 |pages=1392–8; discussion 1400 |year=2009 |month=May |pmid=19379872 |doi=10.1016/j.athoracsur.2009.02.032 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)00309-9 |accessdate=2011-12-04}}</ref><ref name="pmid9054744">{{cite journal |author=Weintraub WS, Jones EL, Morris DC, King SB, Guyton RA, Craver JM |title=Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery |journal=[[Circulation]] |volume=95 |issue=4 |pages=868–77 |year=1997 |month=February |pmid=9054744 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9054744 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[CABG]] or PCI should not be performed with the primary or sole intent to improve survival in patients with [[chronic stable angina definition|stable ischemic heart disease]] with 1 or more [[stenosis|coronary stenoses]] that are not anatomically or functionally significant (e.g., greater than 70% diameter non–left main coronary artery stenosis, [[Fractional flow reserve|fractional flow reserve]] 0.80, no or only mild [[ischemia]] on noninvasive testing), involve only the [[Left circumflex artery|left circumflex]] or [[right coronary artery]], or subtend only a small area of viable myocardium. <ref name="pmid7914958">{{cite journal |author=Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R |title=Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration |journal=[[Lancet]] |volume=344 |issue=8922 |pages=563–70 |year=1994 |month=August |pmid=7914958 |doi= |url= |accessdate=2011-12-04}}</ref><ref name="pmid8622299">{{cite journal |author=Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM |title=Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=111 |issue=5 |pages=1013–25 |year=1996 |month=May |pmid=8622299 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(96)70378-1 |accessdate=2011-12-04}}</ref><ref name="pmid9832692">{{cite journal |author=Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, Fromm B |title=Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=116 |issue=6 |pages=997–1004 |year=1998 |month=December |pmid=9832692 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522398004759 |accessdate=2011-12-04}}</ref><ref name="pmid12771008">{{cite journal |author=Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS |title=Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography |journal=[[Circulation]] |volume=107 |issue=23 |pages=2900–7 |year=2003 |month=June |pmid=12771008 |doi=10.1161/01.CIR.0000072790.23090.41 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12771008 |accessdate=2011-12-04}}</ref><ref name="pmid18268144">{{cite journal |author=Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, Weintraub WS, O'Rourke RA, Dada M, Spertus JA, Chaitman BR, Friedman J, Slomka P, Heller GV, Germano G, Gosselin G, Berger P, Kostuk WJ, Schwartz RG, Knudtson M, Veledar E, Bates ER, McCallister B, Teo KK, Boden WE |title=Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy |journal=[[Circulation]] |volume=117 |issue=10 |pages=1283–91 |year=2008 |month=March |pmid=18268144 |doi=10.1161/CIRCULATIONAHA.107.743963 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18268144 |accessdate=2011-12-04}}</ref><ref name="pmid6332274">{{cite journal |author=Cashin WL, Sanmarco ME, Nessim SA, Blankenhorn DH |title=Accelerated progression of atherosclerosis in coronary vessels with minimal lesions that are bypassed |journal=[[The New England Journal of Medicine]] |volume=311 |issue=13 |pages=824–8 |year=1984 |month=September |pmid=6332274 |doi=10.1056/NEJM198409273111304 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198409273111304?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2011-12-04}}</ref><ref name="pmid8637515">{{cite journal |author=Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, Koolen JJ |title=Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses |journal=[[The New England Journal of Medicine]] |volume=334 |issue=26 |pages=1703–8 |year=1996 |month=June |pmid=8637515 |doi=10.1056/NEJM199606273342604 |url=http://dx.doi.org/10.1056/NEJM199606273342604 |accessdate=2011-12-04}}</ref><ref name="pmid19144937">{{cite journal |author=Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t  Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF |title=Fractional flow reserve versus angiography for guiding percutaneous coronary intervention |journal=[[The New England Journal of Medicine]] |volume=360 |issue=3 |pages=213–24 |year=2009 |month=January |pmid=19144937 |doi=10.1056/NEJMoa0807611 |url=http://dx.doi.org/10.1056/NEJMoa0807611 |accessdate=2011-12-04}}</ref><ref name="pmid14680734">{{cite journal |author=Sawada S, Bapat A, Vaz D, Weksler J, Fineberg N, Greene A, Gradus-Pizlo I, Feigenbaum H |title=Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=12 |pages=2099–105 |year=2003 |month=December |pmid=14680734 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703012737 |accessdate=2011-12-04}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Revascularization to Improve Symptoms <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] or [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms is beneficial in patients with 1 or more significant (greater than 70% diameter) coronary artery [[stenoses]] amenable to [[Chronic stable angina revascularization|revascularization]] and unacceptable [[chronic stable angina|angina]] despite [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]]. <ref name="pmid17387127">{{cite journal |author=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 |title=Optimal medical therapy with or without PCI for stable coronary disease |journal=[[The New England Journal of Medicine]] |volume=356 |issue=15 |pages=1503–16 |year=2007 |month=April |pmid=17387127 |doi=10.1056/NEJMoa070829 |url=http://dx.doi.org/10.1056/NEJMoa070829 |accessdate=2011-12-06}}</ref><ref name="pmid11583747">{{cite journal |author= |title=Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial |journal=[[Lancet]] |volume=358 |issue=9286 |pages=951–7 |year=2001 |month=September |pmid=11583747 |doi=10.1016/S0140-6736(01)06100-1 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(01)06100-1 |accessdate=2011-12-06}}</ref><ref name="pmid12928741">{{cite journal |author=Benzer W, Höfer S, Oldridge NB |title=Health-related quality of life in patients with coronary artery disease after different treatments for angina in routine clinical practice |journal=[[Herz]] |volume=28 |issue=5 |pages=421–8 |year=2003 |month=August |pmid=12928741 |doi=10.1007/s00059-003-2388-9 |url=http://dx.doi.org/10.1007/s00059-003-2388-9 |accessdate=2011-12-06}}</ref><ref name="pmid16174598">{{cite journal |author=Bonaros N, Schachner T, Ohlinger A, Friedrich G, Laufer G, Bonatti J |title=Assessment of health-related quality of life after coronary revascularization |journal=[[The Heart Surgery Forum]] |volume=8 |issue=5 |pages=E380–5 |year=2005 |pmid=16174598 |doi=10.1532/HSF98.20051139 |url=http://cardenjennings.metapress.com/openurl.asp?genre=article&id=doi:10.1532/HSF98.20051139 |accessdate=2011-12-06}}</ref><ref name="pmid10884254">{{cite journal |author=Bucher HC, Hengstler P, Schindler C, Guyatt GH |title=Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials |journal=[[BMJ (Clinical Research Ed.)]] |volume=321 |issue=7253 |pages=73–7 |year=2000 |month=July |pmid=10884254 |pmc=27425 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=10884254 |accessdate=2011-12-06}}</ref><ref name="pmid16876891">{{cite journal |author=Favarato ME, Hueb W, Boden WE, Lopes N, Nogueira CR, Takiuti M, Góis AF, Borges JC, Favarato D, Aldrighi JM, Oliveira SA, Ramires JA |title=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 |journal=[[International Journal of Cardiology]] |volume=116 |issue=3 |pages=364–70 |year=2007 |month=April |pmid=16876891 |doi=10.1016/j.ijcard.2006.06.001 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00478-5 |accessdate=2011-12-06}}</ref><ref name="pmid20733102">{{cite journal |author=Hueb W, Lopes N, Gersh BJ, Soares PR, Ribeiro EE, Pereira AC, Favarato D, Rocha AS, Hueb AC, Ramires JA |title=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 |journal=[[Circulation]] |volume=122 |issue=10 |pages=949–57 |year=2010 |month=September |pmid=20733102 |doi=10.1161/CIRCULATIONAHA.109.911669 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=20733102 |accessdate=2011-12-06}}</ref><ref name="pmid8674171">{{cite journal |author=Pocock SJ, Henderson RA, Seed P, Treasure T, Hampton JR |title=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 |journal=[[Circulation]] |volume=94 |issue=2 |pages=135–42 |year=1996 |month=July |pmid=8674171 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=8674171 |accessdate=2011-12-06}}</ref><ref name="pmid10732887">{{cite journal |author=Pocock SJ, Henderson RA, Clayton T, Lyman GH, Chamberlain DA |title=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=[[Journal of the American College of Cardiology]] |volume=35 |issue=4 |pages=907–14 |year=2000 |month=March |pmid=10732887 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109799006373 |accessdate=2011-12-06}}</ref><ref name="pmid18703470">{{cite journal |author=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 |title=Effect of PCI on quality of life in patients with stable coronary disease |journal=[[The New England Journal of Medicine]] |volume=359 |issue=7 |pages=677–87 |year=2008 |month=August |pmid=18703470 |doi=10.1056/NEJMoa072771 |url=http://dx.doi.org/10.1056/NEJMoa072771 |accessdate=2011-12-06}}</ref><ref name="pmid20231568">{{cite journal |author=Wijeysundera HC, Nallamothu BK, Krumholz HM, Tu JV, Ko DT |title=Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief |journal=[[Annals of Internal Medicine]] |volume=152 |issue=6 |pages=370–9 |year=2010 |month=March |pmid=20231568 |doi=10.1059/0003-4819-152-6-201003160-00007 |url= |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] or [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms is reasonable in patients with 1 or more significant (greater than 70% diameter) coronary artery stenoses and unacceptable [[chronic stable angina|angina]] for whom [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]] cannot be implemented because of medication contraindications, adverse effects, or patient preferences. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms is reasonable in patients with previous [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]], 1 or more significant (greater than 70% diameter) coronary artery stenoses associated with [[ischemia]], and unacceptable [[chronic stable angina|angina]] despite [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]]. <ref name="pmid17045681">{{cite journal |author=Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA |title=Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery |journal=[[International Journal of Cardiology]] |volume=119 |issue=1 |pages=65–72 |year=2007 |month=June |pmid=17045681 |doi=10.1016/j.ijcard.2006.07.058 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(06)00905-3 |accessdate=2011-12-06}}</ref><ref name="pmid10467648">{{cite journal |author=Pfautsch P, Frantz E, Ellmer A, Sauer HU, Fleck E |title=[Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization] |language=German |journal=[[Zeitschrift Für Kardiologie]] |volume=88 |issue=7 |pages=489–97 |year=1999 |month=July |pmid=10467648 |doi= |url=http://link.springer.de/link/service/journals/00392/bibs/9088007/90880489.htm |accessdate=2011-12-06}}</ref><ref name="pmid19379872">{{cite journal |author=Subramanian S, Sabik JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW |title=Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending |journal=[[The Annals of Thoracic Surgery]] |volume=87 |issue=5 |pages=1392–8; discussion 1400 |year=2009 |month=May |pmid=19379872 |doi=10.1016/j.athoracsur.2009.02.032 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)00309-9 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''3.''' It is reasonable to choose [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] over [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] to improve symptoms in patients with complex 3-vessel [[CAD]] (e.g., [[SYNTAX|SYNTAX score]] greater than 22), with or without involvement of the [[LAD|proximal LAD artery]] who are good candidates for [[CABG]]. <ref name="pmid18216353">{{cite journal |author=Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH |title=Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease |journal=[[The New England Journal of Medicine]] |volume=358 |issue=4 |pages=331–41 |year=2008 |month=January |pmid=18216353 |doi=10.1056/NEJMoa071804 |url=http://dx.doi.org/10.1056/NEJMoa071804 |accessdate=2011-12-06}}</ref><ref name="pmid21697170">{{cite journal |author=Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A |title=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 |journal=[[European Heart Journal]] |volume=32 |issue=17 |pages=2125–34 |year=2011 |month=September |pmid=21697170 |doi=10.1093/eurheartj/ehr213 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21697170 |accessdate=2011-12-06}}</ref><ref name="pmid15117846">{{cite journal |author=Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS |title=Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features |journal=[[Circulation]] |volume=109 |issue=19 |pages=2290–5 |year=2004 |month=May |pmid=15117846 |doi=10.1161/01.CIR.0000126826.58526.14 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15117846 |accessdate=2011-12-06}}</ref><ref name="pmid15917382">{{cite journal |author=Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA |title=Long-term outcomes of coronary-artery bypass grafting versus stent implantation |journal=[[The New England Journal of Medicine]] |volume=352 |issue=21 |pages=2174–83 |year=2005 |month=May |pmid=15917382 |doi=10.1056/NEJMoa040316 |url=http://dx.doi.org/10.1056/NEJMoa040316 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' [[Chronic stable angina revascularization coronary artery bypass grafting|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 [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]], and unacceptable [[chronic stable angina|angina]] despite [[Chronic stable angina guidelines for pharmacotherapy to improve prognosis and reduce symptoms|guideline-directed medical therapy]]. <ref name="pmid9054744">{{cite journal |author=Weintraub WS, Jones EL, Morris DC, King SB, Guyton RA, Craver JM |title=Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery |journal=[[Circulation]] |volume=95 |issue=4 |pages=868–77 |year=1997 |month=February |pmid=9054744 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9054744 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' [[Chronic stable angina transmyocardial revascularization|Transmyocardial laser revascularization]] performed as an adjunct to [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] to improve symptoms may be reasonable in patients with viable [[ischemia|ischemic myocardium]] that is perfused by arteries that are not
amenable to grafting. <ref name="pmid10028979">{{cite journal |author=Schofield PM, Sharples LD, Caine N, Burns S, Tait S, Wistow T, Buxton M, Wallwork J |title=Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial |journal=[[Lancet]] |volume=353 |issue=9152 |pages=519–24 |year=1999 |month=February |pmid=10028979 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673698114782 |accessdate=2011-12-06}}</ref><ref name="pmid10758957">{{cite journal |author=Aaberge L, Nordstrand K, Dragsund M, Saatvedt K, Endresen K, Golf S, Geiran O, Abdelnoor M, Forfang K |title=Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris. Clinical results from the Norwegian randomized trial |journal=[[Journal of the American College of Cardiology]] |volume=35 |issue=5 |pages=1170–7 |year=2000 |month=April |pmid=10758957 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00519-2 |accessdate=2011-12-06}}</ref><ref name="pmid10489946">{{cite journal |author=Burkhoff D, Schmidt S, Schulman SP, Myers J, Resar J, Becker LC, Weiss J, Jones JW |title=Transmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomised trial. ATLANTIC Investigators. Angina Treatments-Lasers and Normal Therapies in Comparison |journal=[[Lancet]] |volume=354 |issue=9182 |pages=885–90 |year=1999 |month=September |pmid=10489946 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673699081131 |accessdate=2011-12-06}}</ref><ref name="pmid10694615">{{cite journal |author=Allen KB, Dowling RD, DelRossi AJ, Realyvasques F, Lefrak EA, Pfeffer TA, Fudge TL, Mostovych M, Schuch D, Szentpetery S, Shaar CJ |title=Transmyocardial laser revascularization combined with coronary artery bypass grafting: a multicenter, blinded, prospective, randomized, controlled trial |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=119 |issue=3 |pages=540–9 |year=2000 |month=March |pmid=10694615 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522300795882 |accessdate=2011-12-06}}</ref><ref name="pmid12062729">{{cite journal |author=Stamou SC, Boyce SW, Cooke RH, Carlos BD, Sweet LC, Corso PJ |title=One-year outcome after combined coronary artery bypass grafting and transmyocardial laser revascularization for refractory angina pectoris |journal=[[The American Journal of Cardiology]] |volume=89 |issue=12 |pages=1365–8 |year=2002 |month=June |pmid=12062729 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914902023482 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] or [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] 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 [[Chronic stable angina revascularization|revascularization]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===Clinical factors that may influence the choice of revascularization: Dual Antiplatelet Therapy Compliance and Stent Thrombosis <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' PCI with coronary stenting ([[BMS]] or [[DES]]) should not be performed if the patient is not likely to be able to tolerate and comply with [[dual antiplatelet therapy]] ([[DAPT]]) for the appropriate duration of treatment based on the type of stent implanted. <ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February |pmid=17291948 |doi=10.1016/j.jacc.2007.01.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X |accessdate=2011-12-06}}</ref><ref name="pmid9834303">{{cite journal |author=Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, Giambartolomei A, Diver DJ, Lasorda DM, Williams DO, Pocock SJ, Kuntz RE |title=A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators |journal=[[The New England Journal of Medicine]] |volume=339 |issue=23 |pages=1665–71 |year=1998 |month=December |pmid=9834303 |doi=10.1056/NEJM199812033392303 |url=http://dx.doi.org/10.1056/NEJM199812033392303 |accessdate=2011-12-06}}</ref><ref name="pmid17296821">{{cite journal |author=Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE |title=Stent thrombosis in randomized clinical trials of drug-eluting stents |journal=[[The New England Journal of Medicine]] |volume=356 |issue=10 |pages=1020–9 |year=2007 |month=March |pmid=17296821 |doi=10.1056/NEJMoa067731 |url=http://dx.doi.org/10.1056/NEJMoa067731 |accessdate=2011-12-06}}</ref><ref name="pmid15500897">{{cite journal |author=McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, Suddath WO, Weissman NJ, Torguson R, Kent KM, Pichard AD, Satler LF, Waksman R, Serruys PW |title=Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy |journal=[[Lancet]] |volume=364 |issue=9444 |pages=1519–21 |year=2004 |pmid=15500897 |doi=10.1016/S0140-6736(04)17275-9 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673604172759 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Hybrid Coronary Revascularization <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' Hybrid coronary revascularization (defined as the planned combination of [[LIMA|left internal mammary artery]]-to-[[LAD|LAD artery]] grafting and PCI of ≥1 non-LAD coronary arteries) is reasonable in patients with 1 or more
of the following: <ref name="pmid19147039">{{cite journal |author=Zhao DX, Leacche M, Balaguer JM, Boudoulas KD, Damp JA, Greelish JP, Byrne JG, Ahmad RM, Ball SK, Cleator JH, Deegan RJ, Eagle SS, Fong PP, Fredi JL, Hoff SJ, Jennings HS, McPherson JA, Piana RN, Pretorius M, Robbins MA, Slosky DA, Thompson A |title=Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room |journal=[[Journal of the American College of Cardiology]] |volume=53 |issue=3 |pages=232–41 |year=2009 |month=January |pmid=19147039 |doi=10.1016/j.jacc.2008.10.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03463-3 |accessdate=2011-12-06}}</ref><ref name="pmid16678575">{{cite journal |author=Vassiliades TA, Douglas JS, Morris DC, Block PC, Ghazzal Z, Rab ST, Cates CU |title=Integrated coronary revascularization with drug-eluting stents: immediate and seven-month outcome |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=131 |issue=5 |pages=956–62 |year=2006 |month=May |pmid=16678575 |doi=10.1016/j.jtcvs.2005.10.058 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)00017-1 |accessdate=2011-12-06}}</ref><ref name="pmid17971657">{{cite journal |author=Bonatti J, Schachner T, Bonaros N, Jonetzko P, Ohlinger A, Ruetzler E, Kolbitsch C, Feuchtner G, Laufer G, Pachinger O, Friedrich G |title=Simultaneous hybrid coronary revascularization using totally endoscopic left internal mammary artery bypass grafting and placement of rapamycin eluting stents in the same interventional session. The COMBINATION pilot study |journal=[[Cardiology]] |volume=110 |issue=2 |pages=92–5 |year=2008 |pmid=17971657 |doi=10.1159/000110486 |url=http://content.karger.com/produktedb/produkte.asp?DOI=000110486&typ=pdf |accessdate=2011-12-06}}</ref><ref name="pmid17308384">{{cite journal |author=Gilard M, Bezon E, Cornily JC, Mansourati J, Mondine P, Barra JA, Boschat J |title=Same-day combined percutaneous coronary intervention and coronary artery surgery |journal=[[Cardiology]] |volume=108 |issue=4 |pages=363–7 |year=2007 |pmid=17308384 |doi=10.1159/000099110 |url=http://content.karger.com/produktedb/produkte.asp?DOI=000099110&typ=pdf |accessdate=2011-12-06}}</ref><ref name="pmid19021994">{{cite journal |author=Holzhey DM, Jacobs S, Mochalski M, Merk D, Walther T, Mohr FW, Falk V |title=Minimally invasive hybrid coronary artery revascularization |journal=[[The Annals of Thoracic Surgery]] |volume=86 |issue=6 |pages=1856–60 |year=2008 |month=December |pmid=19021994 |doi=10.1016/j.athoracsur.2008.08.034 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)01820-1 |accessdate=2011-12-06}}</ref><ref name="pmid18242270">{{cite journal |author=Kon ZN, Brown EN, Tran R, Joshi A, Reicher B, Grant MC, Kallam S, Burris N, Connerney I, Zimrin D, Poston RS |title=Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=135 |issue=2 |pages=367–75 |year=2008 |month=February |pmid=18242270 |pmc=2962576 |doi=10.1016/j.jtcvs.2007.09.025 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(07)01592-9 |accessdate=2011-12-06}}</ref><ref name="pmid18371473">{{cite journal |author=Reicher B, Poston RS, Mehra MR, Joshi A, Odonkor P, Kon Z, Reyes PA, Zimrin DA |title=Simultaneous "hybrid" percutaneous coronary intervention and minimally invasive surgical bypass grafting: feasibility, safety, and clinical outcomes |journal=[[American Heart Journal]] |volume=155 |issue=4 |pages=661–7 |year=2008 |month=April |pmid=18371473 |pmc=2636970 |doi=10.1016/j.ahj.2007.12.032 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00071-9 |accessdate=2011-12-06}}</ref>
 
:'''a.''' Limitations to traditional [[CABG]], such as [[Dystrophic calcification|heavily calcified]] [[aorta|proximal aorta]] or poor target vessels for [[CABG]] (but amenable to PCI); ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' Lack of suitable graft conduits; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''c.''' Unfavorable [[LAD|LAD artery]] or PCI (i.e., [[Angulation and tortuosity|excessive vessel tortuosity]] or [[Treatment of chronic total occlusions|chronic total occlusion]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' Hybrid coronary revascularization (defined as the planned combination of [[LIMA|left internal mammary artery]]-to-[[LAD|LAD artery]] grafting and PCI of ≥1 non-LAD coronary arteries) may be reasonable as an alternative to multivessel PCI or [[CABG]] in an attempt to improve the overall risk-benefit ratio of the procedures. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Pre-procedural Considerations <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Radiation Safety <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' Cardiac catheterization laboratories should routinely record relevant available patient procedural radiation dose data (e.g., total air kerma at the international reference point [Ka,r], air kerma air product [PKA], fluoroscopy time, number of cine images), and should define thresholds with corresponding follow-up protocols for patients who receive a high procedural radiation dose. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===Contrast-Induced Acute Kidney Injury <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' 1. Patients should be assessed for risk of [[Contrast induced nephropathy|contrast-induced acute kidney injury]] before PCI.<ref name="pmid15464318">{{cite journal |author=Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G |title=A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=7 |pages=1393–9 |year=2004 |month=October |pmid=15464318 |doi=10.1016/j.jacc.2004.06.068 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01445-7 |accessdate=2011-12-06}}</ref><ref name="pmid16461821">{{cite journal |author=Moscucci M, Rogers EK, Montoye C, Smith DE, Share D, O'Donnell M, Maxwell-Eward A, Meengs WL, De Franco AC, Patel K, McNamara R, McGinnity JG, Jani SM, Khanal S, Eagle KA |title=Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions |journal=[[Circulation]] |volume=113 |issue=6 |pages=814–22 |year=2006 |month=February |pmid=16461821 |doi=10.1161/CIRCULATIONAHA.105.541995 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16461821 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' Patients undergoing cardiac catheterization with [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should receive adequate preparatory [[Contrast induced nephropathy#Hydration with or without bicarbonate|hydration]].<ref name="pmid15267006">{{cite journal |author=Bader BD, Berger ED, Heede MB, Silberbaur I, Duda S, Risler T, Erley CM |title=What is the best hydration regimen to prevent contrast media-induced nephrotoxicity? |journal=[[Clinical Nephrology]] |volume=62 |issue=1 |pages=1–7 |year=2004 |month=July |pmid=15267006 |doi= |url= |accessdate=2011-12-06}}</ref><ref name="pmid11822926">{{cite journal |author=Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H |title=Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty |journal=[[Archives of Internal Medicine]] |volume=162 |issue=3 |pages=329–36 |year=2002 |month=February |pmid=11822926 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=11822926 |accessdate=2011-12-06}}</ref><ref name="pmid7969280">{{cite journal |author=Solomon R, Werner C, Mann D, D'Elia J, Silva P |title=Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents |journal=[[The New England Journal of Medicine]] |volume=331 |issue=21 |pages=1416–20 |year=1994 |month=November |pmid=7969280 |doi=10.1056/NEJM199411243312104 |url=http://dx.doi.org/10.1056/NEJM199411243312104 |accessdate=2011-12-06}}</ref><ref name="pmid12411756">{{cite journal |author=Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, Hewett J |title=A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity |journal=[[Nephron. Clinical Practice]] |volume=93 |issue=1 |pages=C29–34 |year=2003 |month=January |pmid=12411756 |doi= |url= |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' In patients with [[Chronic kidney disease|chronic kidney disease (CKD)]] ([[creatinine clearance]] ≤60 mL/min), the volume of [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should be minimized.<ref name="pmid19189906">{{cite journal |author=Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia F, Fabbiocchi F, Bartorelli AL |title=Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality |journal=[[Annals of Internal Medicine]] |volume=150 |issue=3 |pages=170–7 |year=2009 |month=February |pmid=19189906 |doi= |url= |accessdate=2011-12-06}}</ref><ref name="pmid9375704">{{cite journal |author=McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW |title=Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality |journal=[[The American Journal of Medicine]] |volume=103 |issue=5 |pages=368–75 |year=1997 |month=November |pmid=9375704 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(97)00150-2 |accessdate=2011-12-06}}</ref><ref name="pmid8589322">{{cite journal |author=Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L |title=Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure |journal=[[Journal of the American Society of Nephrology : JASN]] |volume=6 |issue=5 |pages=1451–8 |year=1995 |month=November |pmid=8589322 |doi= |url=http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=8589322 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' Administration of [[Contrast induced nephropathy#N-acetylcysteine|N-acetyl-L-cysteine]] is not useful for the [[Contrast induced nephropathy#Prevention|prevention of contrast-induced acute kidney injury]].<ref name="pmid18001477">{{cite journal |author=Gonzales DA, Norsworthy KJ, Kern SJ, Banks S, Sieving PC, Star RA, Natanson C, Danner RL |title=A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity |journal=[[BMC Medicine]] |volume=5 |issue= |pages=32 |year=2007 |pmid=18001477 |pmc=2200657 |doi=10.1186/1741-7015-5-32 |url=http://www.biomedcentral.com/1741-7015/5/32 |accessdate=2011-12-06}}</ref><ref name="pmid17719303">{{cite journal |author=Ozcan EE, Guneri S, Akdeniz B, Akyildiz IZ, Senaslan O, Baris N, Aslan O, Badak O |title=Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial |journal=[[American Heart Journal]] |volume=154 |issue=3 |pages=539–44 |year=2007 |month=September |pmid=17719303 |doi=10.1016/j.ahj.2007.05.012 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00430-9 |accessdate=2011-12-06}}</ref><ref name="pmid20466200">{{cite journal |author=Thiele H, Hildebrand L, Schirdewahn C, Eitel I, Adams V, Fuernau G, Erbs S, Linke A, Diederich KW, Nowak M, Desch S, Gutberlet M, Schuler G |title=Impact of high-dose N-acetylcysteine versus placebo on contrast-induced nephropathy and myocardial reperfusion injury in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. The LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) Trial |journal=[[Journal of the American College of Cardiology]] |volume=55 |issue=20 |pages=2201–9 |year=2010 |month=May |pmid=20466200 |doi=10.1016/j.jacc.2009.08.091 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)00950-2 |accessdate=2011-12-06}}</ref><ref name="pmid15389228">{{cite journal |author=Webb JG, Pate GE, Humphries KH, Buller CE, Shalansky S, Al Shamari A, Sutander A, Williams T, Fox RS, Levin A |title=A randomized controlled trial of intravenous N-acetylcysteine for the prevention of contrast-induced nephropathy after cardiac catheterization: lack of effect |journal=[[American Heart Journal]] |volume=148 |issue=3 |pages=422–9 |year=2004 |month=September |pmid=15389228 |doi=10.1016/j.ahj.2004.03.041 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870304001875 |accessdate=2011-12-06}}</ref><ref name="pmid21859972">{{cite journal |author= |title=Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT) |journal=[[Circulation]] |volume=124 |issue=11 |pages=1250–9 |year=2011 |month=September |pmid=21859972 |doi=10.1161/CIRCULATIONAHA.111.038943 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21859972 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
 
===Anaphylactoid Reactions <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' Patients with prior evidence of an [[Anaphylaxis|anaphylactoid reaction]] to contrast media should receive appropriate [[steroid]] and [[antihistamine]] prophylaxis before repeat contrast administration.<ref name="pmid19830793">{{cite journal |author=Klein LW, Sheldon MW, Brinker J, Mixon TA, Skelding K, Strunk AO, Tommaso CL, Weiner B, Bailey SR, Uretsky B, Kern M, Laskey W |title=The use of radiographic contrast media during PCI: a focused review: a position statement of the Society of Cardiovascular Angiography and Interventions |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=74 |issue=5 |pages=728–46 |year=2009 |month=November |pmid=19830793 |doi=10.1002/ccd.22113 |url=http://dx.doi.org/10.1002/ccd.22113 |accessdate=2011-12-06}}</ref><ref name="pmid12859162">{{cite journal |author=Levine GN, Kern MJ, Berger PB, Brown DL, Klein LW, Kereiakes DJ, Sanborn TA, Jacobs AK |title=Management of patients undergoing percutaneous coronary revascularization |journal=[[Annals of Internal Medicine]] |volume=139 |issue=2 |pages=123–36 |year=2003 |month=July |pmid=12859162 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=12859162 |accessdate=2011-12-06}}</ref><ref name="pmid16880193">{{cite journal |author=Tramèr MR, von Elm E, Loubeyre P, Hauser C |title=Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review |journal=[[BMJ (Clinical Research Ed.)]] |volume=333 |issue=7570 |pages=675 |year=2006 |month=September |pmid=16880193 |pmc=1584363 |doi=10.1136/bmj.38905.634132.AE |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=16880193 |accessdate=2011-12-06}}</ref><ref name="pmid2866755">{{cite journal |author=Greenberger PA, Patterson R, Tapio CM |title=Prophylaxis against repeated radiocontrast media reactions in 857 cases. Adverse experience with cimetidine and safety of beta-adrenergic antagonists |journal=[[Archives of Internal Medicine]] |volume=145 |issue=12 |pages=2197–200 |year=1985 |month=December |pmid=2866755 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=2866755 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' In patients with a prior history of allergic reactions to shellfish or seafood, anaphylactoid prophylaxis for contrast reaction is not beneficial.<ref name="pmid1170768">{{cite journal |author=Shehadi WH |title=Adverse reactions to intravascularly administered contrast media. A comprehensive study based on a prospective survey |journal=[[The American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine]] |volume=124 |issue=1 |pages=145–52 |year=1975 |month=May |pmid=1170768 |doi= |url= |accessdate=2011-12-06}}</ref><ref name="pmid19665776">{{cite journal |author=Gill BV, Rice TR, Cartier A, Gautrin D, Neis B, Horth-Susin L, Jong M, Swanson M, Lehrer SB |title=Identification of crab proteins that elicit IgE reactivity in snow crab-processing workers |journal=[[The Journal of Allergy and Clinical Immunology]] |volume=124 |issue=5 |pages=1055–61 |year=2009 |month=November |pmid=19665776 |doi=10.1016/j.jaci.2009.06.030 |url=http://linkinghub.elsevier.com/retrieve/pii/S0091-6749(09)00986-5 |accessdate=2011-12-06}}</ref><ref name="pmid11971005">{{cite journal |author=Swoboda I, Bugajska-Schretter A, Verdino P, Keller W, Sperr WR, Valent P, Valenta R, Spitzauer S |title=Recombinant carp parvalbumin, the major cross-reactive fish allergen: a tool for diagnosis and therapy of fish allergy |journal=[[Journal of Immunology (Baltimore, Md. : 1950)]] |volume=168 |issue=9 |pages=4576–84 |year=2002 |month=May |pmid=11971005 |doi= |url=http://www.jimmunol.org/cgi/pmidlookup?view=long&pmid=11971005 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===Statin Treatment <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' Administration of a [[Statin|high-dose statin]] is reasonable before PCI to reduce the risk of peri-procedural [[myocardial infarction]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]] for [[statin]]-naïve patients)'' <ref name="pmid15474697">{{cite journal |author=Briguori C, Colombo A, Airoldi F, Violante A, Focaccio A, Balestrieri P, Paolo Elia P, Golia B, Lepore S, Riviezzo G, Scarpato P, Librera M, Bonizzoni E, Ricciardelli B |title=Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction |journal=[[European Heart Journal]] |volume=25 |issue=20 |pages=1822–8 |year=2004 |month=October |pmid=15474697 |doi=10.1016/j.ehj.2004.07.017 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15474697 |accessdate=2011-12-06}}</ref><ref name="pmid19664895">{{cite journal |author=Briguori C, Visconti G, Focaccio A, Golia B, Chieffo A, Castelli A, Mussardo M, Montorfano M, Ricciardelli B, Colombo A |title=Novel approaches for preventing or limiting events (Naples) II trial: impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2157–63 |year=2009 |month=December |pmid=19664895 |doi=10.1016/j.jacc.2009.07.005 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02248-7 |accessdate=2011-12-06}}</ref><ref name="pmid15277322">{{cite journal |author=Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G |title=Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) study |journal=[[Circulation]] |volume=110 |issue=6 |pages=674–8 |year=2004 |month=August |pmid=15277322 |doi=10.1161/01.CIR.0000137828.06205.87 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15277322 |accessdate=2011-12-06}}</ref><ref name="pmid17394957">{{cite journal |author=Patti G, Pasceri V, Colonna G, Miglionico M, Fischetti D, Sardella G, Montinaro A, Di Sciascio G |title=Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=12 |pages=1272–8 |year=2007 |month=March |pmid=17394957 |doi=10.1016/j.jacc.2007.02.025 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00661-4 |accessdate=2011-12-06}}</ref><ref name="pmid18706705">{{cite journal |author=Yun KH, Jeong MH, Oh SK, Rhee SJ, Park EM, Lee EM, Yoo NJ, Kim NH, Ahn YK, Jeong JW |title=The beneficial effect of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome |journal=[[International Journal of Cardiology]] |volume=137 |issue=3 |pages=246–51 |year=2009 |month=November |pmid=18706705 |doi=10.1016/j.ijcard.2008.06.055 |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(08)00853-X |accessdate=2011-12-06}}</ref><ref name="pmid20384433">{{cite journal |author=Zhang F, Dong L, Ge J |title=Effect of statins pretreatment on periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention: a meta-analysis |journal=[[Annals of Medicine]] |volume=42 |issue=3 |pages=171–7 |year=2010 |month=April |pmid=20384433 |doi=10.3109/07853890903463976 |url=http://informahealthcare.com/doi/abs/10.3109/07853890903463976 |accessdate=2011-12-06}}</ref><ref name="pmid20825761">{{cite journal |author=Winchester DE, Wen X, Xie L, Bavry AA |title=Evidence of pre-procedural statin therapy a meta-analysis of randomized trials |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=14 |pages=1099–109 |year=2010 |month=September |pmid=20825761 |doi=10.1016/j.jacc.2010.04.023 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01920-0 |accessdate=2011-12-06}}</ref>; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]] for those on chronic statin therapy)'' <ref name="pmid19643320">{{cite journal |author=Di Sciascio G, Patti G, Pasceri V, Gaspardone A, Colonna G, Montinaro A |title=Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention: results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=6 |pages=558–65 |year=2009 |month=August |pmid=19643320 |doi=10.1016/j.jacc.2009.05.028 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)01858-0 |accessdate=2011-12-06}}</ref>}}
 
===Bleeding Risk <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' All patients should be evaluated for risk of bleeding before PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===Role of Onsite Surgical Backup===
 
=====Primary PCI in Hospitals Without On-Site Surgical Backup <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' Primary PCI is reasonable in hospitals without on-site cardiac surgery, provided that appropriate planning for program development has been accomplished.<ref name="pmid11960536">{{cite journal |author=Aversano T, Aversano LT, Passamani E, Knatterud GL, Terrin ML, Williams DO, Forman SA |title=Thrombolytic therapy vs primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery: a randomized controlled trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=287 |issue=15 |pages=1943–51 |year=2002 |month=April |pmid=11960536 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11960536 |accessdate=2011-12-06}}</ref><ref name="pmid17278155">{{cite journal |author=Dehmer GJ, Blankenship J, Wharton TP, Seth A, Morrison DA, Dimario C, Muller D, Kellett M, Uretsky BF |title=The current status and future direction of percutaneous coronary intervention without on-site surgical backup: an expert consensus document from the Society for Cardiovascular Angiography and Interventions |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=69 |issue=4 |pages=471–8 |year=2007 |month=March |pmid=17278155 |doi=10.1002/ccd.21097 |url=http://dx.doi.org/10.1002/ccd.21097 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' Primary or elective PCI should not be performed in hospitals without on-site cardiac surgery capabilities without a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital or without appropriate hemodynamic support capability for transfer. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
=====Elective PCI in Hospitals Without On-Site Surgical Backup <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>=====
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' Elective PCI might be considered in hospitals without on-site cardiac surgery, provided that appropriate planning for program development has been accomplished and rigorous clinical and angiographic criteria are used for proper patient selection.<ref name="pmid17278155">{{cite journal |author=Dehmer GJ, Blankenship J, Wharton TP, Seth A, Morrison DA, Dimario C, Muller D, Kellett M, Uretsky BF |title=The current status and future direction of percutaneous coronary intervention without on-site surgical backup: an expert consensus document from the Society for Cardiovascular Angiography and Interventions |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=69 |issue=4 |pages=471–8 |year=2007 |month=March |pmid=17278155 |doi=10.1002/ccd.21097 |url=http://dx.doi.org/10.1002/ccd.21097 |accessdate=2011-12-06}}</ref><ref name="pmid17070152">{{cite journal |author=Melberg T, Nilsen DW, Larsen AI, Barvik S, Bonarjee V, Kuiper KK, Nordrehaug JE |title=Nonemergent coronary angioplasty without on-site surgical backup: a randomized study evaluating outcomes in low-risk patients |journal=[[American Heart Journal]] |volume=152 |issue=5 |pages=888–95 |year=2006 |month=November |pmid=17070152 |doi=10.1016/j.ahj.2006.06.026 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(06)00622-3 |accessdate=2011-12-06}}</ref><ref name="pmid19918168">{{cite journal |author=Singh PP, Singh M, Bedi US, Adigopula S, Singh S, Kodumuri V, Molnar J, Ahmed A, Arora R, Khosla S |title=Outcomes of nonemergent percutaneous coronary intervention with and without on-site surgical backup: a meta-analysis |journal=[[American Journal of Therapeutics]] |volume=18 |issue=2 |pages=e22–8 |year=2011 |pmid=19918168 |doi=10.1097/MJT.0b013e3181bc0f5a |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1075-2765&volume=18&issue=2&spage=e22 |accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' Primary or elective PCI should not be performed in hospitals without on-site cardiac surgery capabilities without a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital or without appropriate hemodynamic support capability for transfer. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Procedural Considerations <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Vascular Access <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' The use of [[Radial artery catheterization|radial artery access]] can be useful to decrease access site complications.<ref name="pmid19926042">Brueck M, Bandorski D, Kramer W, Wieczorek M, Höltgen R, Tillmanns H (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19926042 A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty.] ''JACC Cardiovasc Interv'' 2 (11):1047-54. [http://dx.doi.org/10.1016/j.jcin.2009.07.016 DOI:10.1016/j.jcin.2009.07.016] PMID: [http://pubmed.gov/19926042 19926042]</ref><ref name="pmid17191214">Jaffe R, Hong T, Sharieff W, Chisholm RJ, Kutryk MJ, Charron T et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17191214 Comparison of radial versus femoral approach for percutaneous coronary interventions in octogenarians.] ''Catheter Cardiovasc Interv'' 69 (6):815-20. [http://dx.doi.org/10.1002/ccd.21021 DOI:10.1002/ccd.21021] PMID: [http://pubmed.gov/17191214 17191214]</ref><ref name="pmid19081409">Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19081409 Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials.] ''Am Heart J'' 157 (1):132-40. [http://dx.doi.org/10.1016/j.ahj.2008.08.023 DOI:10.1016/j.ahj.2008.08.023] PMID: [http://pubmed.gov/19081409 19081409]</ref><ref name="pmid15518616">Louvard Y, Benamer H, Garot P, Hildick-Smith D, Loubeyre C, Rigattieri S et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15518616 Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS study).] ''Am J Cardiol'' 94 (9):1177-80. [http://dx.doi.org/10.1016/j.amjcard.2004.07.089 DOI:10.1016/j.amjcard.2004.07.089] PMID: [http://pubmed.gov/15518616 15518616]</ref><ref name="pmid19036757">Pristipino C, Trani C, Nazzaro MS, Berni A, Patti G, Patrizi R et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19036757 Major improvement of percutaneous cardiovascular procedure outcomes with radial artery catheterisation: results from the PREVAIL study.] ''Heart'' 95 (6):476-82. [http://dx.doi.org/10.1136/hrt.2008.150714 DOI:10.1136/hrt.2008.150714] PMID: [http://pubmed.gov/19036757 19036757]</ref><ref name="pmid19463333">Rao SV, Ou FS, Wang TY, Roe MT, Brindis R, Rumsfeld JS et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19463333 Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry.] ''JACC Cardiovasc Interv'' 1 (4):379-86. [http://dx.doi.org/10.1016/j.jcin.2008.05.007 DOI:10.1016/j.jcin.2008.05.007] PMID: [http://pubmed.gov/19463333 19463333]</ref><ref name="pmid20466199">Rao SV, Cohen MG, Kandzari DE, Bertrand OF, Gilchrist IC (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20466199 The transradial approach to percutaneous coronary intervention: historical perspective, current concepts, and future directions.] ''J Am Coll Cardiol'' 55 (20):2187-95. [http://dx.doi.org/10.1016/j.jacc.2010.01.039 DOI:10.1016/j.jacc.2010.01.039] PMID: [http://pubmed.gov/20466199 20466199]</ref><ref name="pmid19577992">Hamon M, Rasmussen LH, Manoukian SV, Cequier A, Lincoff MA, Rupprecht HJ et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19577992 Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy: the ACUITY trial.] ''EuroIntervention'' 5 (1):115-20. PMID: [http://pubmed.gov/19577992 19577992]</ref><ref name="pmid21470671">Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21470671 Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.] ''Lancet'' 377 (9775):1409-20. [http://dx.doi.org/10.1016/S0140-6736(11)60404-2 DOI:10.1016/S0140-6736(11)60404-2] PMID: [http://pubmed.gov/21470671 21470671]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
 
===PCI in patients with Stable Ischemic Heart Disease (SIHD)===
 
=====Patients With Asymptomatic Ischemia or CCS Class I or II Angina <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable in patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] and with 1 or more significant lesions in 1 or 2 coronary arteries suitable for PCI with a high likelihood of success and a low risk of morbidity and mortality. The vessels to be dilated must subtend a moderate to large area of viable myocardium or be associated with a moderate to severe degree of ischemia on [[Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing|noninvasive testing]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable for patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]], and recurrent stenosis after PCI with a large area of viable myocardium or [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|high-risk criteria on noninvasive testing]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''3.''' Use of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable in patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] with significant [[left main]] [[CAD]] (greater than 50% diameter [[stenosis]]) who are candidates for [[Chronic stable angina revascularization|revascularization]] but are not eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' The effectiveness of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] for patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] who have 2- or 3-vessel disease with significant [[LAD|proximal LAD]] [[CAD]] who are otherwise eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]] with 1 arterial conduit and who have treated [[diabetes]] or [[left ventricular dysfunction|abnormal LV function]] is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] might be considered for patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] with non-proximal [[LAD]] [[CAD]] that subtends a moderate area of viable myocardium and demonstrates [[ischemia]] on
[[Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing|noninvasive testing]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is not recommended in patients with [[Chronic stable angina revascularization with PCI and CABG in asymptomatic patients|asymptomatic ischemia]] or [[Canadian cardiovascular society classification of angina pectoris|CCS class I or II angina]] who do not meet the criteria as listed under the class II recommendations or who have 1 or more of the following:
 
:'''a.''' Only a small area of viable myocardium at risk, ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''b.''' No objective evidence of [[ischemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''c.''' Lesions that have a low likelihood of successful dilatation. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''d.''' Mild symptoms that are unlikely to be due to [[myocardial ischemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''e.''' Factors associated with increased risk of morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''f.''' [[Left main]] [[CAD|disease]] and eligibility for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''g.''' Insignificant disease (less than 50% coronary [[stenosis]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
=====Patients With CCS Class III Angina <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' It is reasonable that [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] be performed in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] and single-vessel or multi-vessel [[CAD]] who are undergoing [[Chronic stable angina pharmacotherapy overview|medical therapy]] and who have 1 or more significant lesions in 1 or more coronary arteries suitable for [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] with a high likelihood of success and low risk of morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' It is reasonable that [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] be performed in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] with single-vessel or multi-vessel [[CAD]] who are undergoing medical therapy with focal saphenous vein graft lesions or multiple stenoses who are poor candidates for reoperative surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''3.''' Use of [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is reasonable in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] with significant [[left main]] [[CAD]] (greater than 50% diameter stenosis) who are candidates for [[Chronic stable angina revascularization|revascularization]] but are not eligible for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] may be considered in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] with single-vessel or multivessel [[CAD]] who are undergoing [[Chronic stable angina pharmacotherapy overview|medical therapy]] and who have 1 or more lesions to be dilated with a reduced likelihood of success. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] may be considered in patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] and no evidence of [[ischemia]] on noninvasive testing or who are undergoing [[Chronic stable angina pharmacotherapy overview|medical therapy]] and have 2- or 3-vessel [[CAD]] with significant [[LAD|proximal LAD]] [[CAD]] and treated [[diabetes]] or [[left ventricular dysfunction|abnormal LV function]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[Chronic stable angina revascularization percutaneous coronary intervention|PCI]] is not recommended for patients with [[Canadian cardiovascular society classification of angina pectoris|CCS class III angina]] with single-vessel or multivessel [[CAD]], no evidence of myocardial injury or [[ischemia]] on objective testing, and no trial of [[Chronic stable angina pharmacotherapy overview|medical therapy]], or who have 1 of the following:
 
:'''a.''' Only a small area of myocardium at risk. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''b.''' All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''c.''' Ahigh risk of procedure-related morbidity or mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''d.''' Insignificant disease (less than 50% coronary stenosis). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''e.''' Significant [[left main]] [[CAD]] and candidacy for [[Chronic stable angina revascularization coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===PCI in patients with Unstable Angina/Non–ST-Elevation Myocardial Infarction <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is indicated in [[UA|UA/NSTEMI]] patients who have refractory angina or hemodynamic or electrical instability (without serious comorbidities or contraindications to such procedures).<ref name="pmid17010789">Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17010789 Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials.] ''J Am Coll Cardiol'' 48 (7):1319-25. [http://dx.doi.org/10.1016/j.jacc.2006.06.050 DOI:10.1016/j.jacc.2006.06.050] PMID: [http://pubmed.gov/17010789 17010789]</ref><ref name="pmid11419424">Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11419424 Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban.] ''N Engl J Med'' 344 (25):1879-87. [http://dx.doi.org/10.1056/NEJM200106213442501 DOI:10.1056/NEJM200106213442501] PMID: [http://pubmed.gov/11419424 11419424]</ref><ref name="pmid20359842">Fox KA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JG et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20359842 Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data.] ''J Am Coll Cardiol'' 55 (22):2435-45. [http://dx.doi.org/10.1016/j.jacc.2010.03.007 DOI:10.1016/j.jacc.2010.03.007] PMID: [http://pubmed.gov/20359842 20359842]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is indicated in initially stabilized [[UA|UA/NSTEMI]] patients (without serious comorbidities or contraindications to such procedures) who have an elevated risk for clinical events.<ref name="pmid11419424">Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11419424 Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban.] ''N Engl J Med'' 344 (25):1879-87. [http://dx.doi.org/10.1056/NEJM200106213442501 DOI:10.1056/NEJM200106213442501] PMID: [http://pubmed.gov/11419424 11419424]</ref><ref name="pmid20359842">Fox KA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JG et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20359842 Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data.] ''J Am Coll Cardiol'' 55 (22):2435-45. [http://dx.doi.org/10.1016/j.jacc.2010.03.007 DOI:10.1016/j.jacc.2010.03.007] PMID: [http://pubmed.gov/20359842 20359842]</ref><ref name="pmid10475181"> (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10475181 Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators.] ''Lancet'' 354 (9180):708-15. PMID: [http://pubmed.gov/10475181 10475181]</ref><ref name="pmid19458363">Mehta SR, Granger CB, Boden WE, Steg PG, Bassand JP, Faxon DP et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19458363 Early versus delayed invasive intervention in acute coronary syndromes.] ''N Engl J Med'' 360 (21):2165-75. [http://dx.doi.org/10.1056/NEJMoa0807986 DOI:10.1056/NEJMoa0807986] PMID: [http://pubmed.gov/19458363 19458363]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
'''3.''' The selection of PCI or CABG as the means of revascularization in the patient with [[acute coronary syndrome]] ([[ACS]]) should generally be based on the same considerations as those without ACS.<ref name="pmid8622299">Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL et al. (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8622299 Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease.] ''J Thorac Cardiovasc Surg'' 111 (5):1013-25. PMID: [http://pubmed.gov/8622299 8622299]</ref><ref name="pmid20359842">Fox KA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JG et al. (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20359842 Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data.] ''J Am Coll Cardiol'' 55 (22):2435-45. [http://dx.doi.org/10.1016/j.jacc.2010.03.007 DOI:10.1016/j.jacc.2010.03.007] PMID: [http://pubmed.gov/20359842 20359842]</ref><ref name="pmid16098419">Rodriguez AE, Baldi J, Fernández Pereira C, Navia J, Rodriguez Alemparte M, Delacasa A et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16098419 Five-year follow-up of the Argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II).] ''J Am Coll Cardiol'' 46 (4):582-8. [http://dx.doi.org/10.1016/j.jacc.2004.12.081 DOI:10.1016/j.jacc.2004.12.081] PMID: [http://pubmed.gov/16098419 16098419]</ref><ref name="pmid17258088">Valgimigli M, Dawkins K, Macaya C, de Bruyne B, Teiger E, Fajadet J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17258088 Impact of stable versus unstable coronary artery disease on 1-year outcome in elective patients undergoing multivessel revascularization with sirolimus-eluting stents: a subanalysis of the ARTS II trial.] ''J Am Coll Cardiol'' 49 (4):431-41. [http://dx.doi.org/10.1016/j.jacc.2006.06.081 DOI:10.1016/j.jacc.2006.06.081] PMID: [http://pubmed.gov/17258088 17258088]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is not recommended in patients with extensive co-morbidities (e.g., [[liver failure|liver]] or [[pulmonary failure]], cancer) in whom:
 
:'''a.''' The risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization, ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''b.''' There is a low likelihood of ACS despite acute chest pain, or ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''c.''' Consent to revascularization will not be granted regardless of the findings. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===PCI in patients with ST-Elevation Myocardial Infarction===
 
=====Coronary Angiography Strategies in STEMI <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' A strategy of immediate [[ST elevation myocardial infarction coronary angiography|coronary angiography]] with intent to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] (or [[ST elevation myocardial infarction coronary artery bypass grafting|emergency CABG]]) in patients with [[STEMI]] is recommended for:
 
:'''a.''' Patients who are candidates for [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]].<ref name="pmid11960536">{{cite journal |author=Aversano T, Aversano LT, Passamani E, Knatterud GL, Terrin ML, Williams DO, Forman SA |title=Thrombolytic therapy vs primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery: a randomized controlled trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=287 |issue=15 |pages=1943–51 |year=2002 |month=April |pmid=11960536 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11960536 |accessdate=2011-12-07}}</ref><ref name="pmid12517460">{{cite journal |author=Keeley EC, Boura JA, Grines CL |title=Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials |journal=[[Lancet]] |volume=361 |issue=9351 |pages=13–20 |year=2003 |month=January |pmid=12517460 |doi=10.1016/S0140-6736(03)12113-7 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)12113-7 |accessdate=2011-12-07}}</ref><ref name="pmid8433726">{{cite journal |author=Zijlstra F, de Boer MJ, Hoorntje JC, Reiffers S, Reiber JH, Suryapranata H |title=A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=328 |issue=10 |pages=680–4 |year=1993 |month=March |pmid=8433726 |doi=10.1056/NEJM199303113281002 |url=http://dx.doi.org/10.1056/NEJM199303113281002 |accessdate=2011-12-07}}</ref><ref name="pmid14871919">{{cite journal |author=Keeley EC, Grines CL |title=Primary coronary intervention for acute myocardial infarction |journal=[[JAMA : the Journal of the American Medical Association]] |volume=291 |issue=6 |pages=736–9 |year=2004 |month=February |pmid=14871919 |doi=10.1001/jama.291.6.736 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=14871919 |accessdate=2011-12-07}}</ref><ref name="pmid17202455">{{cite journal |author=Keeley EC, Hillis LD |title=Primary PCI for myocardial infarction with ST-segment elevation |journal=[[The New England Journal of Medicine]] |volume=356 |issue=1 |pages=47–54 |year=2007 |month=January |pmid=17202455 |doi=10.1056/NEJMct063503 |url=http://dx.doi.org/10.1056/NEJMct063503 |accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
:'''b.''' Patients with [[heart failure|severe heart failure]] or [[cardiogenic shock]] who are suitable candidates for revascularization.<ref name="pmid12392826">{{cite journal |author=Wu AH, Parsons L, Every NR, Bates ER |title=Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2) |journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=8 |pages=1389–94 |year=2002 |month=October |pmid=12392826 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702021733 |accessdate=2011-12-07}}</ref><ref name="pmid10460813">{{cite journal |author=Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH |title=Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock |journal=[[The New England Journal of Medicine]] |volume=341 |issue=9 |pages=625–34 |year=1999 |month=August |pmid=10460813 |doi=10.1056/NEJM199908263410901 |url=http://dx.doi.org/10.1056/NEJM199908263410901 |accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' A strategy of immediate [[ST elevation myocardial infarction coronary angiography|coronary angiography]] (or transfer for immediate coronary angiography) with intent to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable for patients with [[STEMI]], a moderate to large area of myocardium at risk, and evidence of failed [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]].<ref name="pmid16382062">{{cite journal |author=Gershlick AH, Stephens-Lloyd A, Hughes S, Abrams KR, Stevens SE, Uren NG, de Belder A, Davis J, Pitt M, Banning A, Baumbach A, Shiu MF, Schofield P, Dawkins KD, Henderson RA, Oldroyd KG, Wilcox R |title=Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=353 |issue=26 |pages=2758–68 |year=2005 |month=December |pmid=16382062 |doi=10.1056/NEJMoa050849 |url=http://dx.doi.org/10.1056/NEJMoa050849 |accessdate=2011-12-07}}</ref><ref name="pmid17258087">{{cite journal |author=Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO, Kashani A, You JJ, Tu JV, Ko DT |title=Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=4 |pages=422–30 |year=2007 |month=January |pmid=17258087 |doi=10.1016/j.jacc.2006.09.033 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)02661-1 |accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' A strategy of [[ST elevation myocardial infarction coronary angiography|coronary angiography]] (or transfer for coronary angiography) 3 to 24 hours after initiating [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]] with intent to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable for hemodynamically stable patients with [[STEMI]] and evidence for successful [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]] when angiography and revascularization can be performed as soon as logistically feasible in this time frame.<ref name="pmid19747792">{{cite journal |author=Bøhmer E, Hoffmann P, Abdelnoor M, Arnesen H, Halvorsen S |title=Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction) |journal=[[Journal of the American College of Cardiology]] |volume=55 |issue=2 |pages=102–10 |year=2010 |month=January |pmid=19747792 |doi=10.1016/j.jacc.2009.08.007 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02642-4 |accessdate=2011-12-07}}</ref><ref name="pmid18280326">{{cite journal |author=Di Mario C, Dudek D, Piscione F, Mielecki W, Savonitto S, Murena E, Dimopoulos K, Manari A, Gaspardone A, Ochala A, Zmudka K, Bolognese L, Steg PG, Flather M |title=Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial |journal=[[Lancet]] |volume=371 |issue=9612 |pages=559–68 |year=2008 |month=February |pmid=18280326 |doi=10.1016/S0140-6736(08)60268-8 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60268-8 |accessdate=2011-12-07}}</ref><ref name="pmid15380963">{{cite journal |author=Fernandez-Avilés F, Alonso JJ, Castro-Beiras A, Vázquez N, Blanco J, Alonso-Briales J, López-Mesa J, Fernández-Vazquez F, Calvo I, Martínez-Elbal L, San Román JA, Ramos B |title=Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial |journal=[[Lancet]] |volume=364 |issue=9439 |pages=1045–53 |year=2004 |pmid=15380963 |doi=10.1016/S0140-6736(04)17059-1 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673604170591 |accessdate=2011-12-07}}</ref><ref name="pmid20601393">{{cite journal |author=Borgia F, Goodman SG, Halvorsen S, Cantor WJ, Piscione F, Le May MR, Fernández-Avilés F, Sánchez PL, Dimopoulos K, Scheller B, Armstrong PW, Di Mario C |title=Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis |journal=[[European Heart Journal]] |volume=31 |issue=17 |pages=2156–69 |year=2010 |month=September |pmid=20601393 |doi=10.1093/eurheartj/ehq204 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20601393 |accessdate=2011-12-07}}</ref><ref name="pmid19553646">{{cite journal |author=Cantor WJ, Fitchett D, Borgundvaag B, Ducas J, Heffernan M, Cohen EA, Morrison LJ, Langer A, Dzavik V, Mehta SR, Lazzam C, Schwartz B, Casanova A, Goodman SG |title=Routine early angioplasty after fibrinolysis for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=360 |issue=26 |pages=2705–18 |year=2009 |month=June |pmid=19553646 |doi=10.1056/NEJMoa0808276 |url=http://dx.doi.org/10.1056/NEJMoa0808276 |accessdate=2011-12-07}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' A strategy of [[ST elevation myocardial infarction coronary angiography|coronary angiography]] performed before hospital discharge might be reasonable in stable patients with [[STEMI]] who did not undergo cardiac catheterization within 24 hours of STEMI onset. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' A strategy of coronary angiography with intent to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is not recommended in patients with [[STEMI]] in whom the risks of revascularization are likely to outweigh the benefits or when the patient or designee does not want invasive care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
=====Primary PCI of the Infarct Artery <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed in patients within 12 hours of onset of [[STEMI]].<ref name="pmid12517460">{{cite journal |author=Keeley EC, Boura JA, Grines CL |title=Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials |journal=[[Lancet]] |volume=361 |issue=9351 |pages=13–20 |year=2003 |month=January |pmid=12517460 |doi=10.1016/S0140-6736(03)12113-7 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)12113-7 |accessdate=2011-12-08}}</ref><ref name="pmid8433726">{{cite journal |author=Zijlstra F, de Boer MJ, Hoorntje JC, Reiffers S, Reiber JH, Suryapranata H |title=A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=328 |issue=10 |pages=680–4 |year=1993 |month=March |pmid=8433726 |doi=10.1056/NEJM199303113281002 |url=http://dx.doi.org/10.1056/NEJM199303113281002 |accessdate=2011-12-08}}</ref><ref name="pmid14871919">{{cite journal |author=Keeley EC, Grines CL |title=Primary coronary intervention for acute myocardial infarction |journal=[[JAMA : the Journal of the American Medical Association]] |volume=291 |issue=6 |pages=736–9 |year=2004 |month=February |pmid=14871919 |doi=10.1001/jama.291.6.736 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=14871919 |accessdate=2011-12-08}}</ref><ref name="pmid17202455">{{cite journal |author=Keeley EC, Hillis LD |title=Primary PCI for myocardial infarction with ST-segment elevation |journal=[[The New England Journal of Medicine]] |volume=356 |issue=1 |pages=47–54 |year=2007 |month=January |pmid=17202455 |doi=10.1056/NEJMct063503 |url=http://dx.doi.org/10.1056/NEJMct063503 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed in patients with [[STEMI]] presenting to a hospital with [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] capability within 90 minutes of [[Door-to-balloon#EMS-to-balloon (E2B)|first medical contact]] as a systems goal.<ref name="pmid20516415">{{cite journal |author=Lambert L, Brown K, Segal E, Brophy J, Rodes-Cabau J, Bogaty P |title=Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction |journal=[[JAMA : the Journal of the American Medical Association]] |volume=303 |issue=21 |pages=2148–55 |year=2010 |month=June |pmid=20516415 |doi=10.1001/jama.2010.712 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=20516415 |accessdate=2011-12-08}}</ref><ref name="pmid20716739">{{cite journal |author=Terkelsen CJ, Sørensen JT, Maeng M, Jensen LO, Tilsted HH, Trautner S, Vach W, Johnsen SP, Thuesen L, Lassen JF |title=System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention |journal=[[JAMA : the Journal of the American Medical Association]] |volume=304 |issue=7 |pages=763–71 |year=2010 |month=August |pmid=20716739 |doi=10.1001/jama.2010.1139 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=20716739 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed in patients with [[STEMI]] presenting to a hospital without [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] capability within 120 minutes of [[Door-to-balloon#EMS-to-balloon (E2B)|first medical contact]] as a systems goal.<ref name="pmid18268151">{{cite journal |author=Aguirre FV, Varghese JJ, Kelley MP, Lam W, Lucore CL, Gill JB, Page L, Turner L, Davis C, Mikell FL |title=Rural interhospital transfer of ST-elevation myocardial infarction patients for percutaneous coronary revascularization: the Stat Heart Program |journal=[[Circulation]] |volume=117 |issue=9 |pages=1145–52 |year=2008 |month=March |pmid=18268151 |doi=10.1161/CIRCULATIONAHA.107.728519 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18268151 |accessdate=2011-12-08}}</ref><ref name="pmid21232663">{{cite journal |author=Blankenship JC, Scott TD, Skelding KA, Haldis TA, Tompkins-Weber K, Sledgen MY, Donegan MA, Buckley JW, Sartorius JA, Hodgson JM, Berger PB |title=Door-to-balloon times under 90 min can be routinely achieved for patients transferred for ST-segment elevation myocardial infarction percutaneous coronary intervention in a rural setting |journal=[[Journal of the American College of Cardiology]] |volume=57 |issue=3 |pages=272–9 |year=2011 |month=January |pmid=21232663 |doi=10.1016/j.jacc.2010.06.056 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)04381-0 |accessdate=2011-12-08}}</ref><ref name="pmid17673457">{{cite journal |author=Henry TD, Sharkey SW, Burke MN, Chavez IJ, Graham KJ, Henry CR, Lips DL, Madison JD, Menssen KM, Mooney MR, Newell MC, Pedersen WR, Poulose AK, Traverse JH, Unger BT, Wang YL, Larson DM |title=A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction |journal=[[Circulation]] |volume=116 |issue=7 |pages=721–8 |year=2007 |month=August |pmid=17673457 |doi=10.1161/CIRCULATIONAHA.107.694141 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17673457 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''4.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed in patients with [[STEMI]] who develop [[heart failure|severe heart failure]] or [[cardiogenic shock]] and are suitable candidates for revascularization as soon as possible, irrespective of time delay.<ref name="pmid12392826">{{cite journal |author=Wu AH, Parsons L, Every NR, Bates ER |title=Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2) |journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=8 |pages=1389–94 |year=2002 |month=October |pmid=12392826 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702021733 |accessdate=2011-12-08}}</ref><ref name="pmid10460813">{{cite journal |author=Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH |title=Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock |journal=[[The New England Journal of Medicine]] |volume=341 |issue=9 |pages=625–34 |year=1999 |month=August |pmid=10460813 |doi=10.1056/NEJM199908263410901 |url=http://dx.doi.org/10.1056/NEJM199908263410901 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''5.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed as soon as possible in patients with [[STEMI]] and contraindications to [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]] with [[ischemic]] symptoms for less than 12 hours.<ref name="pmid10348528">{{cite journal |author=Zahn R, Schuster S, Schiele R, Seidl K, Voigtländer T, Meyer J, Hauptmann KE, Gottwik M, Berg G, Kunz T, Gieseler U, Jakob M, Senges J |title=Comparison of primary angioplasty with conservative therapy in patients with acute myocardial infarction and contraindications for thrombolytic therapy. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=46 |issue=2 |pages=127–33 |year=1999 |month=February |pmid=10348528 |doi=10.1002/(SICI)1522-726X(199902)46:2<127::AID-CCD2>3.0.CO;2-G |url= |accessdate=2011-12-08}}</ref><ref name="pmid14532318">{{cite journal |author=Grzybowski M, Clements EA, Parsons L, Welch R, Tintinalli AT, Ross MA, Zalenski RJ |title=Mortality benefit of immediate revascularization of acute ST-segment elevation myocardial infarction in patients with contraindications to thrombolytic therapy: a propensity analysis |journal=[[JAMA : the Journal of the American Medical Association]] |volume=290 |issue=14 |pages=1891–8 |year=2003 |month=October |pmid=14532318 |doi=10.1001/jama.290.14.1891 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=14532318 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] is reasonable in patients with [[STEMI]] if there is [[ST elevation myocardial infarction diagnosis#Criteria for Diagnosis of Acute Myocardial Infarction|clinical]] and/or [[ST elevation myocardial infarction electrocardiogram|electrocardiographic]] evidence of ongoing ischemia between 12 and 24 hours after symptom onset.<ref name="pmid7905143">{{cite journal |author= |title=Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group |journal=[[Lancet]] |volume=343 |issue=8893 |pages=311–22 |year=1994 |month=February |pmid=7905143 |doi= |url= |accessdate=2011-12-08}}</ref><ref name="pmid15956631">{{cite journal |author=Schömig A, Mehilli J, Antoniucci D, Ndrepepa G, Markwardt C, Di Pede F, Nekolla SG, Schlotterbeck K, Schühlen H, Pache J, Seyfarth M, Martinoff S, Benzer W, Schmitt C, Dirschinger J, Schwaiger M, Kastrati A |title=Mechanical reperfusion in patients with acute myocardial infarction presenting more than 12 hours from symptom onset: a randomized controlled trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=293 |issue=23 |pages=2865–72 |year=2005 |month=June |pmid=15956631 |doi=10.1001/jama.293.23.2865 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15956631 |accessdate=2011-12-08}}</ref><ref name="pmid21195380">{{cite journal |author=Gierlotka M, Gasior M, Wilczek K, Hawranek M, Szkodzinski J, Paczek P, Lekston A, Kalarus Z, Zembala M, Polonski L |title=Reperfusion by primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction within 12 to 24 hours of the onset of symptoms (from a prospective national observational study [PL-ACS]) |journal=[[The American Journal of Cardiology]] |volume=107 |issue=4 |pages=501–8 |year=2011 |month=February |pmid=21195380 |doi=10.1016/j.amjcard.2010.10.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(10)02091-6 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] might be considered in asymptomatic patients with [[STEMI]] and higher risk presenting between 12 and 24 hours after symptom onset. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] should not be performed in a non-infarct artery at the time of [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] in patients with [[STEMI]] without hemodynamic compromise.<ref name="pmid20530505">{{cite journal |author=Toma M, Buller CE, Westerhout CM, Fu Y, O'Neill WW, Holmes DR, Hamm CW, Granger CB, Armstrong PW |title=Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial |journal=[[European Heart Journal]] |volume=31 |issue=14 |pages=1701–7 |year=2010 |month=July |pmid=20530505 |doi=10.1093/eurheartj/ehq129 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20530505 |accessdate=2011-12-08}}</ref><ref name="pmid21195380">{{cite journal |author=Gierlotka M, Gasior M, Wilczek K, Hawranek M, Szkodzinski J, Paczek P, Lekston A, Kalarus Z, Zembala M, Polonski L |title=Reperfusion by primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction within 12 to 24 hours of the onset of symptoms (from a prospective national observational study [PL-ACS]) |journal=[[The American Journal of Cardiology]] |volume=107 |issue=4 |pages=501–8 |year=2011 |month=February |pmid=21195380 |doi=10.1016/j.amjcard.2010.10.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(10)02091-6 |accessdate=2011-12-08}}</ref><ref name="pmid19778920">{{cite journal |author=Politi L, Sgura F, Rossi R, Monopoli D, Guerri E, Leuzzi C, Bursi F, Sangiorgi GM, Modena MG |title=A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up |journal=[[Heart (British Cardiac Society)]] |volume=96 |issue=9 |pages=662–7 |year=2010 |month=May |pmid=19778920 |doi=10.1136/hrt.2009.177162 |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=19778920 |accessdate=2011-12-08}}</ref><ref name="pmid21816304">{{cite journal |author=Vlaar PJ, Mahmoud KD, Holmes DR, van Valkenhoef G, Hillege HL, van der Horst IC, Zijlstra F, de Smet BJ |title=Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=7 |pages=692–703 |year=2011 |month=August |pmid=21816304 |doi=10.1016/j.jacc.2011.03.046 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)01869-9 |accessdate=2011-12-08}}</ref><ref name="pmid21816305">{{cite journal |author=Kornowski R, Mehran R, Dangas G, Nikolsky E, Assali A, Claessen BE, Gersh BJ, Wong SC, Witzenbichler B, Guagliumi G, Dudek D, Fahy M, Lansky AJ, Stone GW |title=Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=7 |pages=704–11 |year=2011 |month=August |pmid=21816305 |doi=10.1016/j.jacc.2011.02.071 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)01874-2 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
=====Delayed or Elective PCI in Patients with STEMI <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with [[STEMI]] and clinical evidence for [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic failure]] or infarct artery reocclusion.<ref name="pmid16382062">{{cite journal |author=Gershlick AH, Stephens-Lloyd A, Hughes S, Abrams KR, Stevens SE, Uren NG, de Belder A, Davis J, Pitt M, Banning A, Baumbach A, Shiu MF, Schofield P, Dawkins KD, Henderson RA, Oldroyd KG, Wilcox R |title=Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=353 |issue=26 |pages=2758–68 |year=2005 |month=December |pmid=16382062 |doi=10.1056/NEJMoa050849 |url=http://dx.doi.org/10.1056/NEJMoa050849 |accessdate=2011-12-08}}</ref><ref name="pmid17258087">{{cite journal |author=Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO, Kashani A, You JJ, Tu JV, Ko DT |title=Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=4 |pages=422–30 |year=2007 |month=January |pmid=17258087 |doi=10.1016/j.jacc.2006.09.033 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)02661-1 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with [[STEMI]] and a patent infarct artery 3 to 24 hours after [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]].<ref name="pmid20601393">{{cite journal |author=Borgia F, Goodman SG, Halvorsen S, Cantor WJ, Piscione F, Le May MR, Fernández-Avilés F, Sánchez PL, Dimopoulos K, Scheller B, Armstrong PW, Di Mario C |title=Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis |journal=[[European Heart Journal]] |volume=31 |issue=17 |pages=2156–69 |year=2010 |month=September |pmid=20601393 |doi=10.1093/eurheartj/ehq204 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20601393 |accessdate=2011-12-08}}</ref><ref name="pmid19553646">{{cite journal |author=Cantor WJ, Fitchett D, Borgundvaag B, Ducas J, Heffernan M, Cohen EA, Morrison LJ, Langer A, Dzavik V, Mehta SR, Lazzam C, Schwartz B, Casanova A, Goodman SG |title=Routine early angioplasty after fibrinolysis for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=360 |issue=26 |pages=2705–18 |year=2009 |month=June |pmid=19553646 |doi=10.1056/NEJMoa0808276 |url=http://dx.doi.org/10.1056/NEJMoa0808276 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with [[STEMI]] who demonstrate [[ischemia]] on [[Exercise stress testing|noninvasive testing]].<ref name="pmid17488963">{{cite journal |author=Erne P, Schoenenberger AW, Burckhardt D, Zuber M, Kiowski W, Buser PT, Dubach P, Resink TJ, Pfisterer M |title=Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=297 |issue=18 |pages=1985–91 |year=2007 |month=May |pmid=17488963 |doi=10.1001/jama.297.18.1985 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17488963 |accessdate=2011-12-08}}</ref><ref name="pmid9264478">{{cite journal |author=Madsen JK, Grande P, Saunamäki K, Thayssen P, Kassis E, Eriksen U, Rasmussen K, Haunsø S, Nielsen TT, Haghfelt T, Fritz-Hansen P, Hjelms E, Paulsen PK, Alstrup P, Arendrup H, Niebuhr-Jørgensen U, Andersen LI |title=Danish multicenter randomized study of invasive versus conservative treatment in patients with inducible ischemia after thrombolysis in acute myocardial infarction (DANAMI). DANish trial in Acute Myocardial Infarction |journal=[[Circulation]] |volume=96 |issue=3 |pages=748–55 |year=1997 |month=August |pmid=9264478 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9264478 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] of a hemodynamically significant [[stenosis]] in a patent infarct artery greater than 24 hours after [[STEMI]] may be considered as part of an invasive strategy.<ref name="pmid12044375">{{cite journal |author=Stenestrand U, Wallentin L |title=Early revascularisation and 1-year survival in 14-day survivors of acute myocardial infarction: a prospective cohort study |journal=[[Lancet]] |volume=359 |issue=9320 |pages=1805–11 |year=2002 |month=May |pmid=12044375 |doi=10.1016/S0140-6736(02)08710-X |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(02)08710-X |accessdate=2011-12-08}}</ref><ref name="pmid12906964">{{cite journal |author=Alter DA, Tu JV, Austin PC, Naylor CD |title=Waiting times, revascularization modality, and outcomes after acute myocardial infarction at hospitals with and without on-site revascularization facilities in Canada |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=3 |pages=410–9 |year=2003 |month=August |pmid=12906964 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703006405 |accessdate=2011-12-08}}</ref><ref name="pmid12939210">{{cite journal |author=Zeymer U, Uebis R, Vogt A, Glunz HG, Vöhringer HF, Harmjanz D, Neuhaus KL |title=Randomized comparison of percutaneous transluminal coronary angioplasty and medical therapy in stable survivors of acute myocardial infarction with single vessel disease: a study of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte |journal=[[Circulation]] |volume=108 |issue=11 |pages=1324–8 |year=2003 |month=September |pmid=12939210 |doi=10.1161/01.CIR.0000087605.09362.0E |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12939210 |accessdate=2011-12-08}}</ref><ref name="pmid14499226">{{cite journal |author=Gupta M, Chang WC, Van de Werf F, Granger CB, Midodzi W, Barbash G, Pehrson K, Oto A, Toutouzas P, Jansky P, Armstrong PW |title=International differences in in-hospital revascularization and outcomes following acute myocardial infarction: a multilevel analysis of patients in ASSENT-2 |journal=[[European Heart Journal]] |volume=24 |issue=18 |pages=1640–50 |year=2003 |month=September |pmid=14499226 |doi= |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=14499226 |accessdate=2011-12-08}}</ref><ref name="pmid12849652">{{cite journal |author=Gibson CM, Karha J, Murphy SA, James D, Morrow DA, Cannon CP, Giugliano RP, Antman EM, Braunwald E |title=Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the Thrombolysis in Myocardial Infarction trials |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=1 |pages=7–16 |year=2003 |month=July |pmid=12849652 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703005060 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] of a totally occluded infarct artery greater than 24 hours after [[STEMI]] should not be performed in asymptomatic patients with 1- or 2-vessel disease if patients are hemodynamically and electrically stable and do not have evidence of severe [[ischemia]].<ref name="pmid18035076">{{cite journal |author=Ioannidis JP, Katritsis DG |title=Percutaneous coronary intervention for late reperfusion after myocardial infarction in stable patients |journal=[[American Heart Journal]] |volume=154 |issue=6 |pages=1065–71 |year=2007 |month=December |pmid=18035076 |doi=10.1016/j.ahj.2007.07.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00668-0 |accessdate=2011-12-08}}</ref><ref name="pmid15589635">{{cite journal |author=Steg PG, Thuaire C, Himbert D, Carrié D, Champagne S, Coisne D, Khalifé K, Cazaux P, Logeart D, Slama M, Spaulding C, Cohen A, Tirouvanziam A, Montély JM, Rodriguez RM, Garbarz E, Wijns W, Durand-Zaleski I, Porcher R, Brucker L, Chevret S, Chastang C |title=DECOPI (DEsobstruction COronaire en Post-Infarctus): a randomized multi-centre trial of occluded artery angioplasty after acute myocardial infarction |journal=[[European Heart Journal]] |volume=25 |issue=24 |pages=2187–94 |year=2004 |month=December |pmid=15589635 |doi=10.1016/j.ehj.2004.10.019 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15589635 |accessdate=2011-12-08}}</ref><ref name="pmid17105759">{{cite journal |author=Hochman JS, Lamas GA, Buller CE, Dzavik V, Reynolds HR, Abramsky SJ, Forman S, Ruzyllo W, Maggioni AP, White H, Sadowski Z, Carvalho AC, Rankin JM, Renkin JP, Steg PG, Mascette AM, Sopko G, Pfisterer ME, Leor J, Fridrich V, Mark DB, Knatterud GL |title=Coronary intervention for persistent occlusion after myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=355 |issue=23 |pages=2395–407 |year=2006 |month=December |pmid=17105759 |pmc=1995554 |doi=10.1056/NEJMoa066139 |url=http://dx.doi.org/10.1056/NEJMoa066139 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
=====Patients With STEMI: General and Specific Considerations <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' If immediately available, [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] should be performed in patients with [[STEMI]] (including true posterior MI) or MI with new or presumably new [[Left bundle branch block|left bundle-branch block]] who can undergo PCI of the infarct artery within 12 hours of symptom onset, if performed in a timely fashion (balloon inflation goal within 90 minutes of presentation) by persons skilled in the procedure (individuals who perform more than 75 PCI procedures per year, ideally at least 11 PCIs per year for [[STEMI]]). The procedure should be supported by experienced personnel in an appropriate laboratory environment (one that performs more than 200 PCI procedures per year, of which at least 36 are primary PCI for STEMI, and that has cardiac surgery capability). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed as quickly as possible, with a goal of a [[Door-to-balloon#EMS-to-balloon (E2B)|medical contact-to-balloon]] or [[Door-to-balloon|door-to-balloon]] time within 90 minutes. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed for patients less than 75 years old with ST elevation or presumably new [[LBBB|left bundle-branch block]] who develop shock
within 36 hours of [[MI]] and are suitable for revascularization that can be performed within 18 hours of [[shock]], unless further support is futile because of the patient’s wishes or contraindications/unsuitability for further invasive care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed in patients with severe [[congestive heart failure]] and/or [[pulmonary edema]] ([[Killip class|Killip class 3]]) and onset of symptoms within 12 hours. The [[Door-to-balloon#EMS-to-balloon (E2B)|medical contact-to-balloon]] or [[Door-to-balloon|door-to balloon]] time should be as short as possible (i.e., goal within 90 minutes). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] is reasonable for selected patients 75 years or older with [[STEMI|ST elevation]] or [[LBBB|left bundle-branch block]] or who develop [[shock]] within 36 hours of [[MI]] and are suitable for revascularization that can be performed within 18 hours of [[shock]]. Patients with good prior functional status who are suitable for revascularization and agree to invasive care may be selected for such an invasive strategy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' It is reasonable to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] for patients with onset of symptoms within the prior 12 to 24 hours and 1 or more of the following:
 
:'''a.''' Severe [[congestive heart failure]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''b.''' Hemodynamic or electrical instability ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
:'''c.''' Evidence of persistent [[ischemia]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' The benefit of [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] for [[STEMI]] patients eligible for [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]] when performed by an operator who performs fewer than 75 PCI procedures per year (or fewer than 11 PCIs for STEMI per year) is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Elective PCI]] should not be performed in a non-infarct-related artery at the time of primary PCI of the infarct related artery in patients without hemodynamic compromise. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Primary PCI]] should not be performed in asymptomatic patients more than 12 hours after onset of [[STEMI]] who are hemodynamically and electrically stable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
=====PCI in Fibrinolytic-Ineligible Patients <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|Primary PCI]] should be performed in [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic]]-ineligible patients who present with [[STEMI]] within 12 hours of symptom onset. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' It is reasonable to perform [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] for [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic]]-ineligible patients with onset of symptoms within the prior 12 to 24 hours and 1 or more of the following:
 
:'''a.''' Severe [[congestive heart failure]], ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
:'''b.''' Hemodynamic or electrical instability, ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
:'''c.''' Evidence of persistent [[ischemia]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
=====Facilitated PCI <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention#Facilitated PCI|Facilitated PCI]] might be performed as a reperfusion strategy in higher-risk patients when PCI is not immediately available and bleeding risk is low. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
=====Rescue PCI (PCI After Failed Fibrinolysis) <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention#Rescue PCI|Rescue PCI]] should be performed in patients less than 75 years old with [[STEMI|ST elevation]] or [[LBBB|left bundle-branch block]] who develop [[shock]] within 36 hours of [[MI]] and are suitable for revascularization that can be performed within 18 hours of shock, unless further support is futile because of the patient’s wishes or contraindications/unsuitability for further invasive care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention#Rescue PCI|Rescue PCI]] should be performed in patients with severe [[congestive heart failure]] and/or [[pulmonary edema]] ([[Killip class|Killip class 3]]) and onset of symptoms within 12 hours. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention#Rescue PCI|Rescue PCI]] is reasonable for selected patients 75 years or older with [[STEMI|ST elevation]] or [[LBBB|left bundle-branch block]] or who develop shock within 36 hours of [[MI]] and are suitable for revascularization that can be performed within 18 hours of shock. Patients with good prior functional status who are suitable for revascularization and agree to invasive care may be selected for such an invasive strategy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' It is reasonable to perform  [[ST elevation myocardial infarction facilitated percutaneous coronary intervention#Rescue PCI|rescue PCI]] for patients with 1 or more of the following:
:'''a.''' Hemodynamic or electrical instability ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
:'''b.''' Evidence of persistent [[ischemia]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention#Rescue PCI|Rescue PCI]] in the absence of 1 or more of the above class I or IIa indications is not recommended. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
=====PCI After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>=====
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed when there is objective evidence of recurrent [[MI]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed for moderate or severe spontaneous or provocable [[myocardial ischemia]] during recovery from STEMI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed for [[cardiogenic shock]] or hemodynamic instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' It is reasonable to perform routine [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] in patients with [[EF|LV ejection fraction]] less than or equal to 0.40, [[heart failure]], or serious [[ventricular arrhythmias]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' It is reasonable to perform [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] when there is documented clinical [[heart failure]] during the acute episode, even though subsequent evaluation shows preserved LV function ([[EF|LV ejection fraction]] greater than 0.40). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] might be considered as part of an invasive strategy after [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===PCI in patients with Cardiogenic Shock <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' PCI is recommended for patients with [[MI|acute myocardial infarction]] who develop [[cardiogenic shock]] and are suitable candidates.<ref name="pmid10460813">Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10460813 Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock.] ''N Engl J Med'' 341 (9):625-34. [http://dx.doi.org/10.1056/NEJM199908263410901 DOI:10.1056/NEJM199908263410901] PMID: [http://pubmed.gov/10460813 10460813]</ref><ref name="pmid11176812">Hochman JS, Sleeper LA, White HD, Dzavik V, Wong SC, Menon V et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11176812 One-year survival following early revascularization for cardiogenic shock.] ''JAMA'' 285 (2):190-2. PMID: [http://pubmed.gov/11176812 11176812]</ref><ref name="pmid16757723">Hochman JS, Sleeper LA, Webb JG, Dzavik V, Buller CE, Aylward P et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16757723 Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction.] ''JAMA'' 295 (21):2511-5. [http://dx.doi.org/10.1001/jama.295.21.2511 DOI:10.1001/jama.295.21.2511] PMID: [http://pubmed.gov/16757723 16757723]</ref><ref name="pmid10383377">Urban P, Stauffer JC, Bleed D, Khatchatrian N, Amann W, Bertel O et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10383377 A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH.] ''Eur Heart J'' 20 (14):1030-8. [http://dx.doi.org/10.1053/euhj.1998.1353 DOI:10.1053/euhj.1998.1353] PMID: [http://pubmed.gov/10383377 10383377]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' A hemodynamic support device is recommended for patients with [[cardiogenic shock]] after [[STEMI]] who do not quickly stabilize with pharmacological therapy.<ref name="pmid10460813">Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10460813 Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock.] ''N Engl J Med'' 341 (9):625-34. [http://dx.doi.org/10.1056/NEJM199908263410901 DOI:10.1056/NEJM199908263410901] PMID: [http://pubmed.gov/10460813 10460813]</ref><ref name="pmid10985715">Sanborn TA, Sleeper LA, Bates ER, Jacobs AK, Boland J, French JK et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10985715 Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?] ''J Am Coll Cardiol'' 36 (3 Suppl A):1123-9. PMID: [http://pubmed.gov/10985715 10985715]</ref><ref name="pmid12912817">Chen EW, Canto JG, Parsons LS, Peterson ED, Littrell KA, Every NR et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12912817 Relation between hospital intra-aortic balloon counterpulsation volume and mortality in acute myocardial infarction complicated by cardiogenic shock.] ''Circulation'' 108 (8):951-7. [http://dx.doi.org/10.1161/01.CIR.0000085068.59734.E4 DOI:10.1161/01.CIR.0000085068.59734.E4] PMID: [http://pubmed.gov/12912817 12912817]</ref><ref name="pmid11376306">Barron HV, Every NR, Parsons LS, Angeja B, Goldberg RJ, Gore JM et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11376306 The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2.] ''Am Heart J'' 141 (6):933-9. [http://dx.doi.org/10.1067/mhj.2001.115295 DOI:10.1067/mhj.2001.115295] PMID: [http://pubmed.gov/11376306 11376306]</ref><ref name="pmid18250279">Reynolds HR, Hochman JS (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18250279 Cardiogenic shock: current concepts and improving outcomes.] ''Circulation'' 117 (5):686-97. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.613596 DOI:10.1161/CIRCULATIONAHA.106.613596] PMID: [http://pubmed.gov/18250279 18250279]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===PCI in patients with Prior Coronary Bypass Surgery <ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23 |pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9 |accessdate=2011-12-06}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
'''1.''' When technically feasible, [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] should be performed in patients with early [[ischemia]] (usually within 30 days) after [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' It is recommended that distal embolic protection devices be used when technically feasible in patients undergoing [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] to [[Saphenous vein graft|saphenous vein grafts]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with [[ischemia]] that occurs 1 to 3 years after [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] and who have preserved LV function with discrete lesions in graft conduits. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with disabling [[Chronic stable angina|angina]] secondary to new disease in a native coronary circulation after [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. (If [[Chronic stable angina|angina]] is not typical, objective evidence of [[ischemia]] should be obtained.) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable in patients with diseased [[Saphenous vein graft|vein grafts]] more than 3 years after [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''4.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is reasonable when technically feasible in patients with a patent [[LIMA|left internal mammary artery graft]] who have clinically significant obstructions in other vessels. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is not recommended in patients with prior [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] for [[Treatment of chronic total occlusions|chronic total vein graft occlusions]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is not recommended in patients who have multiple target lesions with prior [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] and who have [[CAD|multi-vessel disease]], [[Saphenous vein graft#Saphenous Vein Graft Failure and Patency|failure of multiple SVGs]], and [[Left ventricular dysfunction|impaired LV function]] unless repeat [[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] poses excessive risk due to severe comorbid conditions. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Revascularization Before Non-cardiac Surgery <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' 1. For patients who require [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] and are scheduled for elective non-cardiac surgery in the subsequent 12 months, a strategy of [[balloon angioplasty]], or [[Bare metal stent|BMS implantation]] followed by 4 to 6 weeks of [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]], is reasonable.<ref name="pmid9892591">{{cite journal |author=Berger PB, Bell MR, Hasdai D, Grill DE, Melby S, Holmes DR |title=Safety and efficacy of ticlopidine for only 2 weeks after successful intracoronary stent placement |journal=[[Circulation]] |volume=99 |issue=2 |pages=248–53 |year=1999 |month=January |pmid=9892591 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9892591 |accessdate=2011-12-08}}</ref><ref name="pmid20442357">{{cite journal |author=Cruden NL, Harding SA, Flapan AD, Graham C, Wild SH, Slack R, Pell JP, Newby DE |title=Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery |journal=[[Circulation. Cardiovascular Interventions]] |volume=3 |issue=3 |pages=236–42 |year=2010 |month=June |pmid=20442357 |doi=10.1161/CIRCINTERVENTIONS.109.934703 |url=http://circinterventions.ahajournals.org/cgi/pmidlookup?view=long&pmid=20442357 |accessdate=2011-12-08}}</ref><ref name="pmid19926002">{{cite journal |author=Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF |title=2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=22 |pages=e13–e118 |year=2009 |month=November |pmid=19926002 |doi=10.1016/j.jacc.2009.07.010 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02385-7 |accessdate=2011-12-08}}</ref><ref name="pmid10758971">{{cite journal |author=Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE |title=Catastrophic outcomes of noncardiac surgery soon after coronary stenting |journal=[[Journal of the American College of Cardiology]] |volume=35 |issue=5 |pages=1288–94 |year=2000 |month=April |pmid=10758971 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00521-0 |accessdate=2011-12-08}}</ref><ref name="pmid15757604">{{cite journal |author=Reddy PR, Vaitkus PT |title=Risks of noncardiac surgery after coronary stenting |journal=[[The American Journal of Cardiology]] |volume=95 |issue=6 |pages=755–7 |year=2005 |month=March |pmid=15757604 |doi=10.1016/j.amjcard.2004.11.029 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(04)01882-X |accessdate=2011-12-08}}</ref><ref name="pmid15390248">{{cite journal |author=Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, Lindsay J |title=Major noncardiac surgery following coronary stenting: when is it safe to operate? |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=63 |issue=2 |pages=141–5 |year=2004 |month=October |pmid=15390248 |doi=10.1002/ccd.20124 |url=http://dx.doi.org/10.1002/ccd.20124 |accessdate=2011-12-08}}</ref><ref name="pmid12875757">{{cite journal |author=Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, Melby S, Berger PB |title=Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=2 |pages=234–40 |year=2003 |month=July |pmid=12875757 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703006223 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' For patients with [[Drug eluting stent|drug eluting stent (DES)]] who must undergo urgent surgical procedures that mandate the discontinuation of [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]], it is reasonable to continue [[ST elevation myocardial infarction aspirin therapy|aspirin]] if possible and restart the [[Platelet aggregation inhibitor|P2Y12 inhibitor]] as soon as possible in the immediate postoperative period.<ref name="pmid19926002">{{cite journal |author=Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF |title=2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=22 |pages=e13–e118 |year=2009 |month=November |pmid=19926002 |doi=10.1016/j.jacc.2009.07.010 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02385-7 |accessdate=2011-12-08}}</ref><ref name="pmid17950159">{{cite journal |author=Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW |title=ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=17 |pages=1707–32 |year=2007 |month=October |pmid=17950159 |doi=10.1016/j.jacc.2007.09.001 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02724-6 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' Routine prophylactic [[Chronic stable angina revascularization|coronary revascularization]] should not be performed in patients with [[Chronic stable angina|stable CAD]] before noncardiac surgery.<ref name="pmid16669417">{{cite journal |author=Cinà CS, Devereaux PJ |title=Coronary-artery revascularization before elective major vascular surgery. McFalls EO, ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. N Engl J Med. 2004; 351: 2795-804 |journal=[[Vascular Medicine (London, England)]] |volume=11 |issue=1 |pages=61–3 |year=2006 |month=February |pmid=16669417 |doi= |url=http://vmj.sagepub.com/cgi/pmidlookup?view=long&pmid=16669417 |accessdate=2011-12-08}}</ref><ref name="pmid19327412">{{cite journal |author=Schouten O, van Kuijk JP, Flu WJ, Winkel TA, Welten GM, Boersma E, Verhagen HJ, Bax JJ, Poldermans D |title=Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study) |journal=[[The American Journal of Cardiology]] |volume=103 |issue=7 |pages=897–901 |year=2009 |month=April |pmid=19327412 |doi=10.1016/j.amjcard.2008.12.018 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(08)02173-5 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' Elective non-cardiac surgery should not be performed in the 4 to 6 weeks after [[balloon angioplasty]] or [[Bare metal stent|BMS implantation]] or the 12 months after [[Drug eluting stent|DES implantation]] in patients in whom the [[Platelet aggregation inhibitor|P2Y12 inhibitor]] will need to be discontinued peri-operatively.<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February |pmid=17291948 |doi=10.1016/j.jacc.2007.01.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X |accessdate=2011-12-08}}</ref><ref name="pmid15390248">{{cite journal |author=Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, Lindsay J |title=Major noncardiac surgery following coronary stenting: when is it safe to operate? |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=63 |issue=2 |pages=141–5 |year=2004 |month=October |pmid=15390248 |doi=10.1002/ccd.20124 |url=http://dx.doi.org/10.1002/ccd.20124 |accessdate=2011-12-08}}</ref><ref name="pmid10758971">{{cite journal |author=Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE |title=Catastrophic outcomes of noncardiac surgery soon after coronary stenting |journal=[[Journal of the American College of Cardiology]] |volume=35 |issue=5 |pages=1288–94 |year=2000 |month=April |pmid=10758971 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)00521-0 |accessdate=2011-12-08}}</ref><ref name="pmid17488965">{{cite journal |author=Win HK, Caldera AE, Maresh K, Lopez J, Rihal CS, Parikh MA, Granada JF, Marulkar S, Nassif D, Cohen DJ, Kleiman NS |title=Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents |journal=[[JAMA : the Journal of the American Medical Association]] |volume=297 |issue=18 |pages=2001–9 |year=2007 |month=May |pmid=17488965 |doi=10.1001/jama.297.18.2001 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17488965 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Coronary Stents <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' Before implantation of [[Drug eluting stent|drug eluting stent (DES)]], the interventional cardiologist should discuss with the patient the need for and duration of [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] and the ability of the patient to comply with and tolerate [[Dual antiplatelet therapy|DAPT]].<ref name="pmid17148711">{{cite journal |author=Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, Kramer JM, Harrington RA, Matchar DB, Kandzari DE, Peterson ED, Schulman KA, Califf RM |title=Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation |journal=[[JAMA : the Journal of the American Medical Association]] |volume=297 |issue=2 |pages=159–68 |year=2007 |month=January |pmid=17148711 |doi=10.1001/jama.297.2.joc60179 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17148711 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''2.''' [[Drug eluting stent|Drug eluting stent (DES)]] are useful as an alternative to [[Bare metal stent|BMS]] to reduce the risk of [[restenosis]] in cases in which the risk of restenosis is increased and the patient is likely to be able to tolerate and comply with prolonged [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]]. For elective [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] <ref name="pmid14523139">{{cite journal |author=Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE |title=Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery |journal=[[The New England Journal of Medicine]] |volume=349 |issue=14 |pages=1315–23 |year=2003 |month=October |pmid=14523139 |doi=10.1056/NEJMoa035071 |url=http://dx.doi.org/10.1056/NEJMoa035071 |accessdate=2011-12-08}}</ref><ref name="pmid15078803">{{cite journal |author=Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME |title=One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent: the TAXUS-IV trial |journal=[[Circulation]] |volume=109 |issue=16 |pages=1942–7 |year=2004 |month=April |pmid=15078803 |doi=10.1161/01.CIR.0000127110.49192.72 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15078803 |accessdate=2011-12-08}}</ref><ref name="pmid18815397">{{cite journal |author=Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand SL |title=Drug-eluting or bare-metal stents for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=359 |issue=13 |pages=1330–42 |year=2008 |month=September |pmid=18815397 |doi=10.1056/NEJMoa0801485 |url=http://dx.doi.org/10.1056/NEJMoa0801485 |accessdate=2011-12-08}}</ref><ref name="pmid19420364">{{cite journal |author=Stone GW, Lansky AJ, Pocock SJ, Gersh BJ, Dangas G, Wong SC, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Möckel M, Ochala A, Kellock A, Parise H, Mehran R |title=Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=360 |issue=19 |pages=1946–59 |year=2009 |month=May |pmid=19420364 |doi=10.1056/NEJMoa0810116 |url=http://dx.doi.org/10.1056/NEJMoa0810116 |accessdate=2011-12-08}}</ref><ref name="pmid21872918">{{cite journal |author=Mehilli J, Pache J, Abdel-Wahab M, Schulz S, Byrne RA, Tiroch K, Hausleiter J, Seyfarth M, Ott I, Ibrahim T, Fusaro M, Laugwitz KL, Massberg S, Neumann FJ, Richardt G, Schömig A, Kastrati A |title=Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial |journal=[[Lancet]] |volume=378 |issue=9796 |pages=1071–8 |year=2011 |month=September |pmid=21872918 |doi=10.1016/S0140-6736(11)61255-5 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(11)61255-5 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''; for [[Unstable angina / non ST elevation myocardial infarction|UA/NSTEMI]] <ref name="pmid18815397">{{cite journal |author=Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand SL |title=Drug-eluting or bare-metal stents for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=359 |issue=13 |pages=1330–42 |year=2008 |month=September |pmid=18815397 |doi=10.1056/NEJMoa0801485 |url=http://dx.doi.org/10.1056/NEJMoa0801485 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''; for [[ST elevation myocardial infarction|STEMI]] <ref name="pmid18815397">{{cite journal |author=Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand SL |title=Drug-eluting or bare-metal stents for acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=359 |issue=13 |pages=1330–42 |year=2008 |month=September |pmid=18815397 |doi=10.1056/NEJMoa0801485 |url=http://dx.doi.org/10.1056/NEJMoa0801485 |accessdate=2011-12-08}}</ref><ref name="pmid19420364">{{cite journal |author=Stone GW, Lansky AJ, Pocock SJ, Gersh BJ, Dangas G, Wong SC, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Möckel M, Ochala A, Kellock A, Parise H, Mehran R |title=Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=360 |issue=19 |pages=1946–59 |year=2009 |month=May |pmid=19420364 |doi=10.1056/NEJMoa0810116 |url=http://dx.doi.org/10.1056/NEJMoa0810116 |accessdate=2011-12-08}}</ref><ref name="pmid20872982">{{cite journal |author=Pan XH, Chen YX, Xiang MX, Xu G, Wang JA |title=A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients |journal=[[Journal of Zhejiang University. Science. B]] |volume=11 |issue=10 |pages=754–61 |year=2010 |month=October |pmid=20872982 |pmc=2950236 |doi=10.1631/jzus.B0900302 |url=http://www.zju.edu.cn/jzus/article.php?doi=10.1631/jzus.B0900302 |accessdate=2011-12-08}}</ref><ref name="pmid20978561">{{cite journal |author=Hao PP, Chen YG, Wang XL, Zhang Y |title=Efficacy and safety of drug-eluting stents in patients with acute ST-segment-elevation myocardial infarction: a meta-analysis of randomized controlled trials |journal=[[Texas Heart Institute Journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital]] |volume=37 |issue=5 |pages=516–24 |year=2010 |pmid=20978561 |pmc=2953216 |doi= |url= |accessdate=2011-12-08}}</ref><ref name="pmid21262083">{{cite journal |author=Suh HS, Song HJ, Choi JE, Jang EJ, Son HJ, Lee SM, Kim JS, Choi D |title=Drug-eluting stents versus bare-metal stents in acute myocardial infarction: A systematic review and meta-analysis |journal=[[International Journal of Technology Assessment in Health Care]] |volume=27 |issue=1 |pages=11–22 |year=2011 |month=January |pmid=21262083 |doi=10.1017/S0266462310001340 |url=http://journals.cambridge.org/abstract_S0266462310001340 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''.
 
'''3.''' [[Balloon angioplasty]] or [[Bare metal stent|BMS]] should be used in patients with high bleeding risk, inability to comply with 12 months of [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]], or anticipated invasive or surgical procedures within the next 12 months, during which time [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] may be interrupted.<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February |pmid=17291948 |doi=10.1016/j.jacc.2007.01.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X |accessdate=2011-12-08}}</ref><ref name="pmid16860022">{{cite journal |author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, Hong MK, Kim JJ, Park SJ |title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up |journal=[[The American Journal of Cardiology]] |volume=98 |issue=3 |pages=352–6 |year=2006 |month=August |pmid=16860022 |doi=10.1016/j.amjcard.2006.02.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)00720-X |accessdate=2011-12-08}}</ref><ref name="pmid16769908">{{cite journal |author=Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, Messenger JC, Khanal S, Peterson ED, Bach RG, Krumholz HM, Cohen DJ |title=Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry |journal=[[Circulation]] |volume=113 |issue=24 |pages=2803–9 |year=2006 |month=June |pmid=16769908 |doi=10.1161/CIRCULATIONAHA.106.618066 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16769908 |accessdate=2011-12-08}}</ref><ref name="pmid15926177">{{cite journal |author=Nasser M, Kapeliovich M, Markiewicz W |title=Late thrombosis of sirolimus-eluting stents following noncardiac surgery |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=65 |issue=4 |pages=516–9 |year=2005 |month=August |pmid=15926177 |doi=10.1002/ccd.20391 |url=http://dx.doi.org/10.1002/ccd.20391 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' PCI with [[stent|coronary stenting]] should not be performed if the patient is not likely to be able to tolerate and comply with [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]].<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February |pmid=17291948 |doi=10.1016/j.jacc.2007.01.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X |accessdate=2011-12-08}}</ref><ref name="pmid9834303">{{cite journal |author=Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, Giambartolomei A, Diver DJ, Lasorda DM, Williams DO, Pocock SJ, Kuntz RE |title=A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators |journal=[[The New England Journal of Medicine]] |volume=339 |issue=23 |pages=1665–71 |year=1998 |month=December |pmid=9834303 |doi=10.1056/NEJM199812033392303 |url=http://dx.doi.org/10.1056/NEJM199812033392303 |accessdate=2011-12-08}}</ref><ref name="pmid17296821">{{cite journal |author=Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE |title=Stent thrombosis in randomized clinical trials of drug-eluting stents |journal=[[The New England Journal of Medicine]] |volume=356 |issue=10 |pages=1020–9 |year=2007 |month=March |pmid=17296821 |doi=10.1056/NEJMoa067731 |url=http://dx.doi.org/10.1056/NEJMoa067731 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[Drug eluting stent|Drug eluting stent (DES)]] should not be implanted if the patient is not likely to be able to tolerate and comply with prolonged [[Dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] or this cannot be determined before stent implantation.<ref name="pmid17291948">{{cite journal |author=Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P |title=Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=6 |pages=734–9 |year=2007 |month=February |pmid=17291948 |doi=10.1016/j.jacc.2007.01.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00054-X |accessdate=2011-12-08}}</ref><ref name="pmid16860022">{{cite journal |author=Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, Hong MK, Kim JJ, Park SJ |title=Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up |journal=[[The American Journal of Cardiology]] |volume=98 |issue=3 |pages=352–6 |year=2006 |month=August |pmid=16860022 |doi=10.1016/j.amjcard.2006.02.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)00720-X |accessdate=2011-12-08}}</ref><ref name="pmid16769908">{{cite journal |author=Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, Messenger JC, Khanal S, Peterson ED, Bach RG, Krumholz HM, Cohen DJ |title=Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry |journal=[[Circulation]] |volume=113 |issue=24 |pages=2803–9 |year=2006 |month=June |pmid=16769908 |doi=10.1161/CIRCULATIONAHA.106.618066 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16769908 |accessdate=2011-12-08}}</ref><ref name="pmid15926177">{{cite journal |author=Nasser M, Kapeliovich M, Markiewicz W |title=Late thrombosis of sirolimus-eluting stents following noncardiac surgery |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=65 |issue=4 |pages=516–9 |year=2005 |month=August |pmid=15926177 |doi=10.1002/ccd.20391 |url=http://dx.doi.org/10.1002/ccd.20391 |accessdate=2011-12-08}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Adjunctive Diagnostic Devices <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Fractional Flow Reserve <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[Fractional flow reserve]] is reasonable to assess angiographic intermediate coronary lesions (50% to 70% diameter [[stenosis]]) and can be useful for guiding [[Chronic stable angina revascularization|revascularization]] decisions in patients with [[Chronic stable angina|Sudden ischemic heart disease (SIHD)]].<ref name="pmid19144937">{{cite journal |author=Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t  Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF |title=Fractional flow reserve versus angiography for guiding percutaneous coronary intervention |journal=[[The New England Journal of Medicine]] |volume=360 |issue=3 |pages=213–24 |year=2009 |month=January |pmid=19144937 |doi=10.1056/NEJMoa0807611 |url=http://dx.doi.org/10.1056/NEJMoa0807611 |accessdate=2011-12-09}}</ref><ref name="pmid19786633">{{cite journal |author=Hamilos M, Muller O, Cuisset T, Ntalianis A, Chlouverakis G, Sarno G, Nelis O, Bartunek J, Vanderheyden M, Wyffels E, Barbato E, Heyndrickx GR, Wijns W, De Bruyne B |title=Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis |journal=[[Circulation]] |volume=120 |issue=15 |pages=1505–12 |year=2009 |month=October |pmid=19786633 |doi=10.1161/CIRCULATIONAHA.109.850073 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=19786633 |accessdate=2011-12-09}}</ref><ref name="pmid17531660">{{cite journal |author=Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van't Veer M, Bär F, Hoorntje J, Koolen J, Wijns W, de Bruyne B |title=Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study |journal=[[Journal of the American College of Cardiology]] |volume=49 |issue=21 |pages=2105–11 |year=2007 |month=May |pmid=17531660 |doi=10.1016/j.jacc.2007.01.087 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00911-4 |accessdate=2011-12-09}}</ref><ref name="pmid20537493">{{cite journal |author=Pijls NH, Fearon WF, Tonino PA, Siebert U, Ikeno F, Bornschein B, van't Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, De Bruyne B |title=Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=3 |pages=177–84 |year=2010 |month=July |pmid=20537493 |doi=10.1016/j.jacc.2010.04.012 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01602-5 |accessdate=2011-12-09}}</ref><ref name="pmid20579537">{{cite journal |author=Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, Maccarthy PA, Van't Veer M, Pijls NH |title=Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation |journal=[[Journal of the American College of Cardiology]] |volume=55 |issue=25 |pages=2816–21 |year=2010 |month=June |pmid=20579537 |doi=10.1016/j.jacc.2009.11.096 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01439-7 |accessdate=2011-12-09}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
 
===Intravascular Ultrasound <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[Intravascular ultrasound|Intravascular ultrasound (IVUS)]] is reasonable for the assessment of angiographically indeterminant [[left main]] [[CAD]].<ref name="pmid11152827">{{cite journal |author=Briguori C, Anzuini A, Airoldi F, Gimelli G, Nishida T, Adamian M, Corvaja N, Di Mario C, Colombo A |title=Intravascular ultrasound criteria for the assessment of the functional significance of intermediate coronary artery stenoses and comparison with fractional flow reserve |journal=[[The American Journal of Cardiology]] |volume=87 |issue=2 |pages=136–41 |year=2001 |month=January |pmid=11152827 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(00)01304-7 |accessdate=2011-12-09}}</ref><ref name="pmid15653016">{{cite journal |author=Fassa AA, Wagatsuma K, Higano ST, Mathew V, Barsness GW, Lennon RJ, Holmes DR, Lerman A |title=Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease: a long-term follow-up study |journal=[[Journal of the American College of Cardiology]] |volume=45 |issue=2 |pages=204–11 |year=2005 |month=January |pmid=15653016 |doi=10.1016/j.jacc.2004.09.066 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)02064-9 |accessdate=2011-12-09}}</ref><ref name="pmid21266708">{{cite journal |author=Kang SJ, Lee JY, Ahn JM, Mintz GS, Kim WJ, Park DW, Yun SC, Lee SW, Kim YH, Lee CW, Park SW, Park SJ |title=Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity |journal=[[Circulation. Cardiovascular Interventions]] |volume=4 |issue=1 |pages=65–71 |year=2011 |month=February |pmid=21266708 |doi=10.1161/CIRCINTERVENTIONS.110.959148 |url=http://circinterventions.ahajournals.org/cgi/pmidlookup?view=long&pmid=21266708 |accessdate=2011-12-09}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[IVUS]] and [[Coronary catheterization|coronary angiography]] are reasonable 4 to 6 weeks and 1 year after [[Heart transplantation|cardiac transplantation]] to exclude donor [[CAD]], detect rapidly progressive cardiac allograft vasculopathy, and provide prognostic information.<ref name="pmid20643330">{{cite journal |author=Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, Fedson S, Fisher P, Gonzales-Stawinski G, Martinelli L, McGiffin D, Smith J, Taylor D, Meiser B, Webber S, Baran D, Carboni M, Dengler T, Feldman D, Frigerio M, Kfoury A, Kim D, Kobashigawa J, Shullo M, Stehlik J, Teuteberg J, Uber P, Zuckermann A, Hunt S, Burch M, Bhat G, Canter C, Chinnock R, Crespo-Leiro M, Delgado R, Dobbels F, Grady K, Kao W, Lamour J, Parry G, Patel J, Pini D, Towbin J, Wolfel G, Delgado D, Eisen H, Goldberg L, Hosenpud J, Johnson M, Keogh A, Lewis C, O'Connell J, Rogers J, Ross H, Russell S, Vanhaecke J |title=The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients |journal=[[The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation]] |volume=29 |issue=8 |pages=914–56 |year=2010 |month=August |pmid=20643330 |doi=10.1016/j.healun.2010.05.034 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053-2498(10)00358-X |accessdate=2011-12-10}}</ref><ref name="pmid15862430">{{cite journal |author=Kobashigawa JA, Tobis JM, Starling RC, Tuzcu EM, Smith AL, Valantine HA, Yeung AC, Mehra MR, Anzai H, Oeser BT, Abeywickrama KH, Murphy J, Cretin N |title=Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years |journal=[[Journal of the American College of Cardiology]] |volume=45 |issue=9 |pages=1532–7 |year=2005 |month=May |pmid=15862430 |doi=10.1016/j.jacc.2005.02.035 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)00465-1 |accessdate=2011-12-10}}</ref><ref name="pmid9851952">{{cite journal |author=Kapadia SR, Nissen SE, Ziada KM, Guetta V, Crowe TD, Hobbs RE, Starling RC, Young JB, Tuzcu EM |title=Development of transplantation vasculopathy and progression of donor-transmitted atherosclerosis: comparison by serial intravascular ultrasound imaging |journal=[[Circulation]] |volume=98 |issue=24 |pages=2672–8 |year=1998 |month=December |pmid=9851952 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9851952 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[IVUS]] is reasonable to determine the mechanism of stent [[restenosis]]. <ref name="pmid21109112">{{cite journal |author=Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R |title=In-stent restenosis in the drug-eluting stent era |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=23 |pages=1897–907 |year=2010 |month=November |pmid=21109112 |doi=10.1016/j.jacc.2010.07.028 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03986-0 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' [[IVUS]] may be reasonable for the assessment of non–left main coronary arteries with angiographically intermediate [[stenosis|coronary stenoses]] (50% to 70% diameter stenosis).<ref name="pmid11152827">{{cite journal |author=Briguori C, Anzuini A, Airoldi F, Gimelli G, Nishida T, Adamian M, Corvaja N, Di Mario C, Colombo A |title=Intravascular ultrasound criteria for the assessment of the functional significance of intermediate coronary artery stenoses and comparison with fractional flow reserve |journal=[[The American Journal of Cardiology]] |volume=87 |issue=2 |pages=136–41 |year=2001 |month=January |pmid=11152827 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(00)01304-7 |accessdate=2011-12-10}}</ref><ref name="pmid10411848">{{cite journal |author=Takagi A, Tsurumi Y, Ishii Y, Suzuki K, Kawana M, Kasanuki H |title=Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis: relationship between quantitative ultrasound tomography and pressure-derived fractional flow reserve |journal=[[Circulation]] |volume=100 |issue=3 |pages=250–5 |year=1999 |month=July |pmid=10411848 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10411848 |accessdate=2011-12-10}}</ref><ref name="pmid19133668">{{cite journal |author=Magni V, Chieffo A, Colombo A |title=Evaluation of intermediate coronary stenosis with intravascular ultrasound and fractional flow reserve: Its use and abuse |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=73 |issue=4 |pages=441–8 |year=2009 |month=March |pmid=19133668 |doi=10.1002/ccd.21812 |url=http://dx.doi.org/10.1002/ccd.21812 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' [[IVUS]] may be considered for guidance of [[stent|coronary stent]] implantation, particularly in cases of [[left main|left main coronary artery]] stenting.<ref name="pmid15653016">{{cite journal |author=Fassa AA, Wagatsuma K, Higano ST, Mathew V, Barsness GW, Lennon RJ, Holmes DR, Lerman A |title=Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease: a long-term follow-up study |journal=[[Journal of the American College of Cardiology]] |volume=45 |issue=2 |pages=204–11 |year=2005 |month=January |pmid=15653016 |doi=10.1016/j.jacc.2004.09.066 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)02064-9 |accessdate=2011-12-10}}</ref><ref name="pmid21109112">{{cite journal |author=Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R |title=In-stent restenosis in the drug-eluting stent era |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=23 |pages=1897–907 |year=2010 |month=November |pmid=21109112 |doi=10.1016/j.jacc.2010.07.028 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03986-0 |accessdate=2011-12-10}}</ref><ref name="pmid20031713">{{cite journal |author=Park SJ, Kim YH, Park DW, Lee SW, Kim WJ, Suh J, Yun SC, Lee CW, Hong MK, Lee JH, Park SW |title=Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis |journal=[[Circulation. Cardiovascular Interventions]] |volume=2 |issue=3 |pages=167–77 |year=2009 |month=June |pmid=20031713 |doi=10.1161/CIRCINTERVENTIONS.108.799494 |url=http://circinterventions.ahajournals.org/cgi/pmidlookup?view=long&pmid=20031713 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' [[IVUS]] may be reasonable to determine the [[Stent thrombosis mechanism and pathophysiology|mechanism of stent thrombosis]].<ref name="pmid21109112">{{cite journal |author=Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R |title=In-stent restenosis in the drug-eluting stent era |journal=[[Journal of the American College of Cardiology]] |volume=56 |issue=23 |pages=1897–907 |year=2010 |month=November |pmid=21109112 |doi=10.1016/j.jacc.2010.07.028 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)03986-0 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[IVUS]] for routine lesion assessment is not recommended when [[revascularization]] with PCI or [[CABG]] is not being contemplated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Adjunctive Therapeutic Devices <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Coronary Atherectomy <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[Rotational atherectomy]] is reasonable for fibrotic or [[dystrophic calcification|heavily calcified]] lesions that might not be crossed by a [[balloon catheter]] or adequately dilated before [[stent|stent implantation]]. <ref name="pmid9236427">{{cite journal |author=Moussa I, Di Mario C, Moses J, Reimers B, Di Francesco L, Martini G, Tobis J, Colombo A |title=Coronary stenting after rotational atherectomy in calcified and complex lesions. Angiographic and clinical follow-up results |journal=[[Circulation]] |volume=96 |issue=1 |pages=128–36 |year=1997 |month=July |pmid=9236427 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9236427 |accessdate=2011-12-10}}</ref><ref name="pmid20636844">{{cite journal |author=Vaquerizo B, Serra A, Miranda F, Triano JL, Sierra G, Delgado G, Puentes A, Mojal S, Brugera J |title=Aggressive plaque modification with rotational atherectomy and/or cutting balloon before drug-eluting stent implantation for the treatment of calcified coronary lesions |journal=[[Journal of Interventional Cardiology]] |volume=23 |issue=3 |pages=240–8 |year=2010 |month=June |pmid=20636844 |doi=10.1111/j.1540-8183.2010.00547.x |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0896-4327&date=2010&volume=23&issue=3&spage=240 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[Rotational atherectomy]] should not be performed routinely for de-novo lesions or [[stent|in-stent]] [[restenosis]]. <ref name="pmid15028347">{{cite journal |author=Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM |title=Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty |journal=[[Journal of the American College of Cardiology]] |volume=43 |issue=6 |pages=936–42 |year=2004 |month=March |pmid=15028347 |doi=10.1016/j.jacc.2003.10.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109704000142 |accessdate=2011-12-10}}</ref><ref name="pmid12766743">{{cite journal |author=Mauri L, Reisman M, Buchbinder M, Popma JJ, Sharma SK, Cutlip DE, Ho KK, Prpic R, Zimetbaum PJ, Kuntz RE |title=Comparison of rotational atherectomy with conventional balloon angioplasty in the prevention of restenosis of small coronary arteries: results of the Dilatation vs Ablation Revascularization Trial Targeting Restenosis (DART) |journal=[[American Heart Journal]] |volume=145 |issue=5 |pages=847–54 |year=2003 |month=May |pmid=12766743 |doi=10.1016/S0002-8703(03)00080-2 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870303000802 |accessdate=2011-12-10}}</ref><ref name="pmid9236422">{{cite journal |author=Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J |title=Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study |journal=[[Circulation]] |volume=96 |issue=1 |pages=91–8 |year=1997 |month=July |pmid=9236422 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9236422 |accessdate=2011-12-10}}</ref><ref name="pmid11827923">{{cite journal |author=vom Dahl J, Dietz U, Haager PK, Silber S, Niccoli L, Buettner HJ, Schiele F, Thomas M, Commeau P, Ramsdale DR, Garcia E, Hamm CW, Hoffmann R, Reineke T, Klues HG |title=Rotational atherectomy does not reduce recurrent in-stent restenosis: results of the angioplasty versus rotational atherectomy for treatment of diffuse in-stent restenosis trial (ARTIST) |journal=[[Circulation]] |volume=105 |issue=5 |pages=583–8 |year=2002 |month=February |pmid=11827923 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11827923 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
 
===Thrombectomy <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[Thrombectomy|Aspiration thrombectomy]] is reasonable for patients undergoing primary PCI. <ref name="pmid19161878">{{cite journal |author=Sardella G, Mancone M, Bucciarelli-Ducci C, Agati L, Scardala R, Carbone I, Francone M, Di Roma A, Benedetti G, Conti G, Fedele F |title=Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size: the EXPIRA (thrombectomy with export catheter in infarct-related artery during primary percutaneous coronary intervention) prospective, randomized trial |journal=[[Journal of the American College of Cardiology]] |volume=53 |issue=4 |pages=309–15 |year=2009 |month=January |pmid=19161878 |doi=10.1016/j.jacc.2008.10.017 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03542-0 |accessdate=2011-12-10}}</ref><ref name="pmid18539223">{{cite journal |author=Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F |title=Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study |journal=[[Lancet]] |volume=371 |issue=9628 |pages=1915–20 |year=2008 |month=June |pmid=18539223 |doi=10.1016/S0140-6736(08)60833-8 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60833-8 |accessdate=2011-12-10}}</ref><ref name="pmid18812323">{{cite journal |author=Bavry AA, Kumbhani DJ, Bhatt DL |title=Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction: a comprehensive meta-analysis of randomized trials |journal=[[European Heart Journal]] |volume=29 |issue=24 |pages=2989–3001 |year=2008 |month=December |pmid=18812323 |doi=10.1093/eurheartj/ehn421 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18812323 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Laser Angioplasty <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' [[angioplasty|Laser angioplasty]] might be considered for fibrotic or [[Dystrophic calcification|moderately calcified]] lesions that cannot be crossed or dilated with [[balloon angioplasty|conventional balloon angioplasty]]. <ref name="pmid18324694">{{cite journal |author=Noble S, Bilodeau L |title=High energy excimer laser to treat coronary in-stent restenosis in an underexpanded stent |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=71 |issue=6 |pages=803–7 |year=2008 |month=May |pmid=18324694 |doi=10.1002/ccd.21490 |url=http://dx.doi.org/10.1002/ccd.21490 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[angioplasty|Laser angioplasty]] should not be used routinely during PCI. <ref name="pmid15028347">{{cite journal |author=Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM |title=Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty |journal=[[Journal of the American College of Cardiology]] |volume=43 |issue=6 |pages=936–42 |year=2004 |month=March |pmid=15028347 |doi=10.1016/j.jacc.2003.10.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109704000142 |accessdate=2011-12-10}}</ref><ref name="pmid9236422">{{cite journal |author=Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J |title=Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study |journal=[[Circulation]] |volume=96 |issue=1 |pages=91–8 |year=1997 |month=July |pmid=9236422 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9236422 |accessdate=2011-12-10}}</ref><ref name="pmid9385898">{{cite journal |author=Stone GW, de Marchena E, Dageforde D, Foschi A, Muhlestein JB, McIvor M, Rizik D, Vanderlaan R, McDonnell J |title=Prospective, randomized, multicenter comparison of laser-facilitated balloon angioplasty versus stand-alone balloon angioplasty in patients with obstructive coronary artery disease. The Laser Angioplasty Versus Angioplasty (LAVA) Trial Investigators |journal=[[Journal of the American College of Cardiology]] |volume=30 |issue=7 |pages=1714–21 |year=1997 |month=December |pmid=9385898 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109797003872 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
 
===Cutting Balloon Angioplasty <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' [[balloon angioplasty|Cutting balloon angioplasty]] might be considered to avoid slippage induced [[coronary artery]] trauma during PCI for [[stent|in-stent]] [[restenosis]] or ostial lesions in side branches. <ref name="pmid15028348">{{cite journal |author=Albiero R, Silber S, Di Mario C, Cernigliaro C, Battaglia S, Reimers B, Frasheri A, Klauss V, Auge JM, Rubartelli P, Morice MC, Cremonesi A, Schofer J, Bortone A, Colombo A |title=Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results of the restenosis cutting balloon evaluation trial (RESCUT) |journal=[[Journal of the American College of Cardiology]] |volume=43 |issue=6 |pages=943–9 |year=2004 |month=March |pmid=15028348 |doi=10.1016/j.jacc.2003.09.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703017224 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[balloon angioplasty|Cutting balloon angioplasty]] should not be performed routinely during PCI. <ref name="pmid15028347">{{cite journal |author=Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM |title=Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty |journal=[[Journal of the American College of Cardiology]] |volume=43 |issue=6 |pages=936–42 |year=2004 |month=March |pmid=15028347 |doi=10.1016/j.jacc.2003.10.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109704000142 |accessdate=2011-12-10}}</ref><ref name="pmid15028348">{{cite journal |author=Albiero R, Silber S, Di Mario C, Cernigliaro C, Battaglia S, Reimers B, Frasheri A, Klauss V, Auge JM, Rubartelli P, Morice MC, Cremonesi A, Schofer J, Bortone A, Colombo A |title=Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results of the restenosis cutting balloon evaluation trial (RESCUT) |journal=[[Journal of the American College of Cardiology]] |volume=43 |issue=6 |pages=943–9 |year=2004 |month=March |pmid=15028348 |doi=10.1016/j.jacc.2003.09.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703017224 |accessdate=2011-12-10}}</ref><ref name="pmid12423707">{{cite journal |author=Mauri L, Bonan R, Weiner BH, Legrand V, Bassand JP, Popma JJ, Niemyski P, Prpic R, Ho KK, Chauhan MS, Cutlip DE, Bertrand OF, Kuntz RE |title=Cutting balloon angioplasty for the prevention of restenosis: results of the Cutting Balloon Global Randomized Trial |journal=[[The American Journal of Cardiology]] |volume=90 |issue=10 |pages=1079–83 |year=2002 |month=November |pmid=12423707 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S000291490202773X |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
 
===Embolic Protection Devices <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' Embolic protection devices should be used during [[saphenous vein graft]] PCI when technically feasible.<ref name="pmid11901037">{{cite journal |author=Baim DS, Wahr D, George B, Leon MB, Greenberg J, Cutlip DE, Kaya U, Popma JJ, Ho KK, Kuntz RE |title=Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts |journal=[[Circulation]] |volume=105 |issue=11 |pages=1285–90 |year=2002 |month=March |pmid=11901037 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11901037 |accessdate=2011-12-10}}</ref><ref name="pmid18212287">{{cite journal |author=Coolong A, Baim DS, Kuntz RE, O'Malley AJ, Marulkar S, Cutlip DE, Popma JJ, Mauri L |title=Saphenous vein graft stenting and major adverse cardiac events: a predictive model derived from a pooled analysis of 3958 patients |journal=[[Circulation]] |volume=117 |issue=6 |pages=790–7 |year=2008 |month=February |pmid=18212287 |doi=10.1161/CIRCULATIONAHA.106.651232 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18212287 |accessdate=2011-12-10}}</ref><ref name="pmid17919563">{{cite journal |author=Mauri L, Cox D, Hermiller J, Massaro J, Wahr J, Tay SW, Jonas M, Popma JJ, Pavliska J, Wahr D, Rogers C |title=The PROXIMAL trial: proximal protection during saphenous vein graft intervention using the Proxis Embolic Protection System: a randomized, prospective, multicenter clinical trial |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=15 |pages=1442–9 |year=2007 |month=October |pmid=17919563 |doi=10.1016/j.jacc.2007.06.039 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02300-5 |accessdate=2011-12-10}}</ref><ref name="pmid12874191">{{cite journal |author=Stone GW, Rogers C, Hermiller J, Feldman R, Hall P, Haber R, Masud A, Cambier P, Caputo RP, Turco M, Kovach R, Brodie B, Herrmann HC, Kuntz RE, Popma JJ, Ramee S, Cox DA |title=Randomized comparison of distal protection with a filter-based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto-coronary bypass grafts |journal=[[Circulation]] |volume=108 |issue=5 |pages=548–53 |year=2003 |month=August |pmid=12874191 |doi=10.1161/01.CIR.0000080894.51311.0A |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12874191 |accessdate=2011-12-10}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Percutaneous Hemodynamic Support Devices <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08 |url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' Elective insertion of an appropriate hemodynamic support device as an adjunct to PCI may be reasonable in carefully selected high-risk patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Antiplatelet Therapy <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08 |url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Oral Antiplatelet Therapy <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' Patients already taking daily [[Aspirin|aspirin therapy]] should take 81 mg to 325 mg before PCI.(150–153) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' Patients not on [[Aspirin|aspirin therapy]] should be given non-enteric aspirin 325 mg before PCI. (150,152,153) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''3.''' After PCI, use of [[aspirin]] should be continued indefinitely.(275-278) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
'''4.''' A loading dose of a [[Antiplatelet drug|P2Y12 receptor inhibitor]] should be given to patients undergoing PCI with [[Stent|stenting]].(279–283) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' Options include:
 
:'''a.''' [[Clopidogrel]] 600 mg ([[acute coronary syndrome|ACS]] and non-ACS patients).(279–281) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' [[Prasugrel]] 60 mg ([[ACS]] patients).(282) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''c.''' [[Ticagrelor]] 180 mg ([[ACS]] patients).(283) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''5.''' The loading dose of [[clopidogrel]] for patients undergoing PCI after [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]] should be 300 mg within 24 hours and 600 mg more than 24 hours after receiving [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]].(280,284) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''6.''' Patients should be counseled on the need for and risks of [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] before placement of [[Stent|intra-coronary stents]], especially [[drug eluting stent|drug eluting stents (DES)]], and alternative therapies should be pursued if patients are unwilling or unable to comply with the recommended duration of [[dual antiplatelet therapy|dual antiplatelet therapy]].(107) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''7.''' The duration of [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] after [[Stent|stent implantation]] should generally be as follows:
 
:'''a.''' In patients receiving a [[stent]] ([[Bare metal stent|bare metal stent (BMS)]] or [[drug eluting stent|drug eluting stent (DES)]]) during PCI for [[ACS]], [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] should be given for at least 12 months. Options include [[clopidogrel]] 75 mg daily (285), [[prasugrel]] 10 mg daily (282), and [[ticagrelor]] 90 mg twice daily.(283) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''b.''' In patients receiving [[drug eluting stent|drug eluting stent (DES)]] for a non-ACS indication, [[clopidogrel]] 75 mg daily should be given for at least 12 months if patients are not at high risk of bleeding.(107,232,286) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
:'''c.''' In patients receiving [[Bare metal stent|bare metal stent (BMS)]] for a non-ACS indication, [[clopidogrel]] should be given for a minimum of 1 month and ideally up to 12 months (unless the patient is at increased risk of bleeding; then it should be given for a minimum of 2 weeks).(107,287) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' After PCI, it is reasonable to use [[aspirin]] 81 mg per day in preference to higher maintenance doses.(151,288–291) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by a recommended duration of [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] after [[Stent|stent implantation]], earlier discontinuation (e.g.,less than 12 months) of [[Antiplatelet drug|P2Y12 receptor inhibitor therapy]] is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
'''1.''' Continuation of [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]] beyond 12 months may be considered in patients undergoing [[drug eluting stent|drug eluting stent (DES)]] implantation.(282,283) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[Prasugrel]] should not be administered to patients with a prior history of [[stroke]] or [[transient ischemic attack]].(282) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Intravenous Antiplatelet Therapy: ST-Elevation Myocardial Infarction (STEMI) <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' In patients undergoing [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] treated with [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|unfractionated heparin (UFH)]], it is reasonable to administer a [[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition|glycoprotein IIb/IIIa inhibitor]] ([[abciximab]], [[eptifibatide|double-bolus eptifibatide]], or [[tirofiban|high-bolus dose tirofiban]]), whether or not patients were pretreated with [[ST elevation myocardial infarction thienopyridine therapy|clopidogrel]].(292–298) (For [[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition|glycoprotein IIb/IIIa inhibitor]] administration in patients not pretreated with [[ST elevation myocardial infarction thienopyridine therapy|clopidogrel]], ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''; for [[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition|glycoprotein IIb/IIIa inhibitor]] administration in patients pretreated with [[ST elevation myocardial infarction thienopyridine therapy|clopidogrel]], ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'')
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' In patients undergoing [[ST elevation myocardial infarction primary percutaneous coronary intervention#Primary PCI|primary PCI]] with [[abciximab]], it may be reasonable to administer [[abciximab|intracoronary abciximab]].(297,299–312) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' Routine pre-catheterization laboratory (e.g., ambulance or emergency room) administration of [[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition|glycoprotein IIb/IIIa inhibitors]] as part of an upstream strategy for patients with [[STEMI]] undergoing [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] is not beneficial.(313–320) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Intravenous Antiplatelet Therapy: Unstable Angina / Non-ST Elevation Myocardial Infarction (UA/NSTEMI) <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' In [[Unstable angina / non ST elevation myocardial infarction|UA/NSTEMI]] patients with high-risk features (e.g., [[Unstable angina / non ST elevation myocardial infarction biomarkers#Cardiac Troponins|elevated troponin level]]) not treated with [[Unstable angina / non ST elevation myocardial infarction direct thrombin inhibitors therapy|bivalirudin]] and not adequately pre-treated with [[Unstable angina / non ST elevation myocardial infarction thienopyridines|clopidogrel]], it is useful at the time of [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]] to administer a [[Unstable angina / non ST elevation myocardial infarction GPIIb/IIIa inhibitor|GP IIb/IIIa inhibitor]] ([[abciximab]], [[eptifibatide|double-bolus eptifibatide]], or
[[tirofiban|high-bolus dose tirofiban]]) in patients treated with [[Unstable angina / non ST elevation myocardial infarction unfractionated heparin therapy|unfractionated heparin therapy (UFH)]].(321–326) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
'''1.''' In [[Unstable angina / non ST elevation myocardial infarction|UA/NSTEMI]] patients with high-risk features (e.g., [[Unstable angina / non ST elevation myocardial infarction biomarkers#Cardiac Troponins|elevated troponin level]]) treated with [[Unstable angina / non ST elevation myocardial infarction unfractionated heparin therapy|unfractionated heparin therapy (UFH)]] and adequately pretreated with [[Unstable angina / non ST elevation myocardial infarction thienopyridines|clopidogrel]], it is reasonable at the time of [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]] to administer a [[Unstable angina / non ST elevation myocardial infarction GPIIb/IIIa inhibitor|GP IIb/IIIa inhibitor]] ([[abciximab]], [[eptifibatide|double-bolus eptifibatide]], or [[tirofiban|high-bolus dose tirofiban]]).(324,327) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Intravenous Antiplatelet Therapy: Sudden Ischemia Heart Disease (SIHD) <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' In patients undergoing [[Chronic stable angina revascularization percutaneous coronary intervention|elective PCI]] treated with [[Heparin|unfractionated heparin (UFH)]] and not pretreated with [[Chronic stable angina treatment clopidogrel|clopidogrel]], it is reasonable to administer a [[Glycoprotein IIb/IIIa inhibitors|GP IIb/IIIa inhibitor]] ([[abciximab]], [[eptifibatide|double-bolus eptifibatide]], or [[tirofiban|high-bolus dose tirofiban]]).(327–329) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' In patients undergoing [[Chronic stable angina revascularization percutaneous coronary intervention|elective PCI]] with [[Stent|stent implantation]] treated with [[Heparin|unfractionated heparin (UFH)]] and adequately pretreated with [[Chronic stable angina treatment clopidogrel|clopidogrel]], it might be reasonable to administer a [[Glycoprotein IIb/IIIa inhibitors|GP IIb/IIIa inhibitor]] ([[abciximab]], [[eptifibatide|double-bolus eptifibatide]], or [[tirofiban|high-bolus dose tirofiban]]).(327,330–332) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Anticoagulant Therapy <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08 |url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Use of Parenteral Anticoagulants during PCI <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' An [[anticoagulant]] should be administered to patients undergoing PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===Unfractionated Heparin <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' Administration of intravenous [[UFH]] is useful in patients undergoing PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===Enoxaparin <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' An additional dose of 0.3 mg/kg [[enoxaparin|intravenous enoxaparin]] should be administered at the time of PCI to patients who have received fewer than 2 therapeutic subcutaneous doses (e.g., 1 mg/kg) or received the last subcutaneous [[enoxaparin]] dose 8 to 12 hours before PCI.(346,350–353) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' Performance of [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]] with [[enoxaparin]] may be reasonable in patients either treated with ''upstream'' [[enoxaparin|subcutaneous enoxaparin]] for [[Unstable angina / non ST elevation myocardial infarction|UA/NSTEMI]] or who have not received prior [[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy|antithrombin therapy]] and are administered [[enoxaparin|intravenous enoxaparin]] at the time of [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]].(343–347) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
'''1.''' [[Unstable angina / non ST elevation myocardial infarction low molecular weight heparin therapy|Unfractionated heparin (UFH)]] should not be given to patients already receiving therapeutic [[enoxaparin|subcutaneous enoxaparin]].(346,354) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Bivalirudin and Argatoban <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' For patients undergoing PCI, [[bivalirudin]] is useful as an anticoagulant with or without prior treatment with [[UFH|unfractionated heparin (UFH)]].(333–342) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' For patients with [[heparin-induced thrombocytopenia]], it is recommended that [[bivalirudin]] or [[argatroban]] be used to replace [[UFH|unfractionated heparin (UFH)]].(355,356) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Fondaparinux <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[Fondaparinux]] should not be used as the sole anticoagulant to support PCI. An additional anticoagulant with anti-IIa activity should be administered because of the risk of [[thrombosis|catheter thrombosis]].(348,349) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===No-Reflow Pharmacological Therapies <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' Administration of an [[vasodilator|intracoronary vasodilator]] ([[adenosine]], [[calcium channel blocker]], or [[nitroprusside]]) is reasonable to treat PCI-related
[[No reflow phenomenon|no-reflow]] that occurs during primary or elective PCI.(357–372) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: PCI in Specific Anatomic Situations <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08 |url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Chronic Total Occlusions <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' [[Treatment of chronic total occlusions#PCI Techniques|PCI]] of a [[Treatment of chronic total occlusions|chronic total occlusion]] in patients with appropriate clinical indications and suitable anatomy is reasonable when performed by operators with appropriate expertise.(373–377) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Saphenous Vein Grafts <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' Embolic protection devices should be used during [[saphenous vein graft|saphenous vein graft PCI]] when technically feasible.(271–274) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]====
 
'''1.''' [[Glycoprotein IIb/IIIa inhibitors|Platelet GP IIb/IIIa inhibitors]] are not beneficial as adjunctive therapy during [[saphenous vein graft|saphenous vein graft PCI]].(232,286,378,379) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' PCI is not recommended for [[saphenous vein graft#Saphenous Vein Graft Failure and Patency|chronic saphenous vein graft occlusions]].(380–382) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
===Bifurcation Lesions <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Aorto-Ostial Stenoses <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
===Calcified Lesions <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: PCI in Specific Patient Population <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
===Chronic Kidney Disease===
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
==2011 ACCF/AHA/SCAI Guideline Recommendations: Peri-procedural Myocardial Infarction Assessment <ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
 
{{cquote|
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
 
==Institutional and Operator Competency==
===Quality Assurance===
* ''Class I''
1. An institution that performs PCI should establish an
ongoing mechanism for valid peer review of its quality
and outcomes. Review should be conducted both at
the level of the entire program and at the level of the
individual practitioner. Quality-assessment reviews
should take risk adjustment, statistical power, and
national benchmark statistics into consideration.
Quality-assessment reviews should include both tabulation
of adverse event rates for comparison with
benchmark values and case review of complicated
procedures and some uncomplicated procedures.
(Level of Evidence: C)
2. An institution that performs PCI should participate in
a recognized PCI data registry for the purpose of
benchmarking its outcomes against current national
norms. (Level of Evidence: C)
 
===Operator and Institutional Volume===
* ''Class I''
1. Elective PCI should be performed by operators with
acceptable annual volume (at least 75 procedures) at
high-volume centers (more than 400 procedures) with
onsite cardiac surgery (310,312). (Level of Evidence:
B)
2. Elective PCI should be performed by operators and
institutions whose historical and current risk-adjusted
outcomes statistics are comparable to those reported
in contemporary national data registries. (Level of
Evidence: C)
3. Primary PCI for STEMI should be performed by
experienced operators who perform more than 75
elective PCI procedures per year and, ideally, at least
11 PCI procedures for STEMI per year. Ideally, these
procedures should be performed in institutions that
perform more than 400 elective PCIs per year and
more than 36 primary PCI procedures for STEMI per
year. (Level of Evidence B)
* ''Class IIa''
1. It is reasonable that operators with acceptable volume
(at least 75 PCI procedures per year) perform PCI at
low-volume centers (200 to 400 PCI procedures per
year) with onsite cardiac surgery (310,312). (Level of
Evidence: B)
2. It is reasonable that low-volume operators (fewer than
75 PCI procedures per year) perform PCI at high-volume
centers (more than 400 PCI procedures per year)
with onsite cardiac surgery (310,312). Ideally, operators
with an annual procedure volume less than 75
should only work at institutions with an activity level
of more than 600 procedures per year. Operators who
perform fewer than 75 procedures per year should
develop a defined mentoring relationship with a highly
experienced operator who has an annual procedural
volume of at least 150 procedures per year. (Level of
Evidence: B)
* ''Class IIb''
The benefit of primary PCI for STEMI patients eligible
for fibrinolysis when performed by an operator
who performs fewer than 75 procedures per year (or
fewer than 11 PCIs for STEMI per year) is not well
established. (Level of Evidence: C)
* ''Class III''
It is not recommended that elective PCI be performed
by low-volume operators (fewer than 75 procedures
per year) at low-volume centers (200 to 400) with or
without onsite cardiac surgery (310,312). An institution
with a volume of fewer than 200 procedures per
year, unless in a region that is underserved because of
geography, should carefully consider whether it
should continue to offer this service. (Level of
Evidence: B)
 
==Guideline Resources==
*[http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf 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]<ref name="pmid22070837">{{cite journal |author=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 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08}}</ref>
 
*[http://content.onlinejacc.org/cgi/reprint/54/23/2205.pdf 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)]<ref name="pmid19942100">Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19942100 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.] ''J Am Coll Cardiol'' 54 (23):2205-41. [http://dx.doi.org/10.1016/j.jacc.2009.10.015 DOI:10.1016/j.jacc.2009.10.015] PMID: [http://pubmed.gov/19942100 19942100]</ref>
 
==References==
{{reflist|2}}
 
{{Circulatory system pathology}}
 
[[Category:Disease]]
[[Category:Cardiology]]
 
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