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| | ==Definition of Multivessel Disease== |
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| ===Management Algorithm for Spontaneous Coronary Artery Dissection <ref name="pmid25406203">{{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 6 | pages= 777-86 | pmid=25406203 | doi=10.1161/CIRCINTERVENTIONS.114.001659 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406203 }} </ref> ===
| | For AEGIS-II inclusion criteria #5, multivessel disease criteria can be met by findings on the cardiac catheterization for the index MI, a prior cardiac catheterization, or both: |
| | * Index MI cardiac catheterization: 50% or greater stenosis of the left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCX, RCA) (prior to any interventions performed) |
| | * Prior cardiac catheterization: 50% or greater stenosis of left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCx, RCA) (prior to any interventions performed) |
| | * Both: Index MI cardiac catheterization with 1 vessel with 50% or greater stenosis (prior to any interventions performed) <b><u>AND</u></b> prior PCI of at least 1 vessel different from index MI vessel |
| | * Prior multivessel CABG |
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| | Multivessel disease requires a 50% or greater stenosis in at least 2 of the 3 major epicardial artery territories (LAD, LCx, RCA) or the left main vessel. Branch vessel disease may qualify as part of the territory of that branch vessel (for example, a diagonal vessel is considered part of the LAD territory). For the purpose of this study, the ramus is considered part of the Left Circumflex artery territory. If a branch vessel is used as a qualifying vessel, that branch should be of large enough size to potentially undergo revascularization if clinically indicated, e.g. >2mm vessel size. |
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| <div style="font-size: 70%;">
| | ==MVD Tool== |
| {{Familytree/start}}
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| {{Familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | | | | | | | A01 | A01=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">'''Spontaneous Coronary Artery Dissection (SCAD)'''</div>}} | | {| |
| {{Familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|.| }}
| | {{#Widget:MVD5}} |
| {{Familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | B01 | | | | | | | | | | B02 | B01= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">'''Stable, no high-risk feature (i.e., left main or proximal 2-vessel coronary artery dissection)'''</div>|B02= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;"> '''High-risk feature present'''</div>}}
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| {{familytree | | | |!| | | | | | | | | | | |!|}}
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| {{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px background: #FFFFFF;| | | |!| | | | | | | C01 | | | | | | C02 | | C03 | | C04 | C01=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Left main dissection</div>|C02=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Ongoing/recurrent ischemia</div>|C03=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Ventricular tachycardia or fibrillation</div>|C04=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 15px;">Cardiogenic shock</div>}}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |`|-|v|-|'|}}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | Z01 | Z01=Hemodynamically unstable?}}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |,|-|^|-|.|}}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | D01 | | D02 | D01=No | D02=Yes }}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!|}}
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| {{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | E01 | E01=<div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Consider: Intra-aortic balloon pump, Extra corporeal membrane oxygenation, Left ventricular assist device, Implantable cardioverter defibrillator</div>}}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!|}}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!|}} | |
| {{familytree | | | |!| | | | | |,|-|^|-|.| | | | | |`|-|v|-|'| | | |!|}}
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| {{familytree | | | |!| | | | | |!| | | |!| | | | | | | |!| | | | | |!|}}
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| {{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | F01 | | F02 | | | | | | F03 |-|-|-|-|'| F01= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Isolated Left Main</div>|F02= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Involving Left Anterior Descending (LAD) +/or circumflex</div>| F03= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Is percutaneous coronary intervention (PCI) feasible?</div>}}
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| {{familytree | | | |!| | | | | |!| | | |!| | | | | | | |!|}}
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| {{familytree | | | |!| | | | | |!| | | |!| | | | | |,|-|^|-|-|-|.|}}
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| {{familytree | | | |!| | | | | |!| | | |!| | | | | G01 | | | | G02 |G01=No | G02=Yes }}
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| {{familytree | | | |!| | | | | |!| | | |!| | | | | |!| | | | | |!|}}
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| {{familytree | | | |!| | | | | |!| | | |!| | | | | H01 | | | | |!|H01 = Ostial LAD or ≥ 2 proximal SCAD?}}
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| {{familytree | | | |!| | | | | |!| | | |!| | | |,|-|^|-|.| | | |!|}}
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| {{familytree | | | I02 | | | | I03 | | |`|-|-| I01 | | I02 | | I03 |I01=Coronary artery bypassing | I02=Conservative therapy | I03=PCI}}
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| {{familytree | | | | | | | | | | | | | |!|}}
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| {{familytree | | | | | | | | | | | | | J01 | J01='''Adjunctive medical therapy''' <BR> Aspirin and beta-blocker (± clopidogrel, ACEI/ARB, statin)}}
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| {{familytree | | | | | | | | | | | | | |!|}}
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| {{familytree | | | | | | | | | | | | | K01 | K01=Monitor in-hospital for 3 to 5 days}}
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| {{Family tree/end}}
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| </div>
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Definition of Multivessel Disease
For AEGIS-II inclusion criteria #5, multivessel disease criteria can be met by findings on the cardiac catheterization for the index MI, a prior cardiac catheterization, or both:
- Index MI cardiac catheterization: 50% or greater stenosis of the left main or at least 2 coronary artery territories (LAD, LCX, RCA) (prior to any interventions performed)
- Prior cardiac catheterization: 50% or greater stenosis of left main or at least 2 coronary artery territories (LAD, LCx, RCA) (prior to any interventions performed)
- Both: Index MI cardiac catheterization with 1 vessel with 50% or greater stenosis (prior to any interventions performed) AND prior PCI of at least 1 vessel different from index MI vessel
- Prior multivessel CABG
Multivessel disease requires a 50% or greater stenosis in at least 2 of the 3 major epicardial artery territories (LAD, LCx, RCA) or the left main vessel. Branch vessel disease may qualify as part of the territory of that branch vessel (for example, a diagonal vessel is considered part of the LAD territory). For the purpose of this study, the ramus is considered part of the Left Circumflex artery territory. If a branch vessel is used as a qualifying vessel, that branch should be of large enough size to potentially undergo revascularization if clinically indicated, e.g. >2mm vessel size.
MVD Tool