Percutaneous coronary intervention (PCI): Difference between revisions

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/* 2011 ACCF/AHA/SCAI Guideline Recommendations: Peri-procedural Myocardial Infarction Assessment{{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, L...
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__NOTOC__
{{Template:Percutaneous Coronary Intervention}}


'''For patient information click [[Angioplasty (patient information)|here]]'''
{{CMG}}; {{AOEIC}} {{LG}}
{{SK}} PCI; balloon angioplasty; percutaneous transluminal angioplasty
==Overview==
'''Percutaneous coronary intervention''' ('''PCI'''), commonly known as '''coronary angioplasty''', is an invasive [[Cardiology|cardiologic]] therapeutic procedure to treat the [[stenosis|stenotic]] (narrowed) [[coronary artery|coronary arteries]] of the [[heart]].  These stenotic segments are due to the build up of [[cholesterol]]-laden plaques that form due to [[coronary heart disease]].
Percutaneous coronary intervention can be performed to reduce or eliminate the symptoms of coronary artery disease, including [[angina pectoris|angina]] (chest pain), dyspnea (shortness of breath) on exertion, and [[congestive heart failure]].  PCI is also used to abort an acute [[myocardial infarction]], and in some specific cases it may reduce [[death|mortality]].
==Epidemiology and Demographics==
* Approximately 850,000 PCIs are performed each year in the United States.
===ACCF/AHA Guidelines for 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>===
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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<nowiki>"</nowiki>'''1.''' [[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>)<nowiki>"</nowiki>
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{|class="wikitable"
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|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
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|bgcolor="LightCoral"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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<nowiki>"</nowiki>'''1.''' 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]])''<nowiki>"</nowiki>
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<nowiki>"</nowiki>'''2.''' [[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]])''<nowiki>"</nowiki>
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
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<nowiki>"</nowiki>'''1.''' 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]])''<nowiki>"</nowiki>
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<nowiki>"</nowiki>'''2.''' 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]])''<nowiki>"</nowiki>
|}
===ACCF/AHA Guidelines for 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>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|bgcolor="LightCoral"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
==Procedure==
The term [[balloon angioplasty]] is commonly used to describe percutaneous coronary intervention, which describes the inflation of a balloon within the coronary artery to crush the plaque into the walls of the artery.  While balloon angioplasty is still done as a part of nearly all percutaneous coronary interventions, it is rarely the only procedure performed.
Other procedures that are done during a percutaneous coronary intervention include:
* Implantation of [[stent]]s
* Rotational or laser [[atherectomy]]
* [[Brachytherapy]]
Balloon angioplasty is now used to facilitate stent deployment.
==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>==
=====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>=====
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|
<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
=====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>
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
=====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>
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
==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>==
===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>
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]])''<nowiki>"</nowiki>
|}
==2011 ACCF/AHA/SCAI Guideline Recommendations: Restenosis <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>==
===Exercise Testing===
<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>
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine periodic stress testing of asymptomatic patients after PCI without specific clinical indications should not be performed.<ref name="pmid15019882">{{cite journal|author=Eisenberg MJ, Blankenship JC, Huynh T, Azrin M, Pathan A, Sedlis S, Panja M, Starling MR, Beyar R, Azoulay A, Caron J, Pilote L |title=Evaluation of routine functional testing after percutaneous coronary intervention |journal=[[The American Journal of Cardiology]] |volume=93|issue=6 |pages=744–7 |year=2004 |month=March |pmid=15019882 |doi=10.1016/j.amjcard.2003.11.071|url=http://linkinghub.elsevier.com/retrieve/pii/S000291490301717X |accessdate=2011-12-16}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients entering a formal cardiac rehabilitation program after PCI, treadmill exercise testing is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Cardiac Rehabilitation===
<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>
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.<ref name="pmid21576654">{{cite journal |author=Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ |title=Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community |journal=[[Circulation]] |volume=123|issue=21 |pages=2344–52 |year=2011 |month=May |pmid=21576654 |doi=10.1161/CIRCULATIONAHA.110.983536|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21576654|accessdate=2011-12-16}}</ref><ref name="pmid15121495">{{cite journal |author=Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N|title=Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials |journal=[[The American Journal of Medicine]]|volume=116 |issue=10 |pages=682–92 |year=2004 |month=May |pmid=15121495|doi=10.1016/j.amjmed.2004.01.009 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002934304001238|accessdate=2011-12-16}}</ref><ref name="pmid19001195">{{cite journal |author=Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, Chieffo C, Gattone M, Griffo R, Schweiger C, Tavazzi L, Urbinati S, Valagussa F, Vanuzzo D |title=Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network|journal=[[Archives of Internal Medicine]] |volume=168 |issue=20 |pages=2194–204 |year=2008|month=November |pmid=19001195 |doi=10.1001/archinte.168.20.2194|url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=19001195|accessdate=2011-12-16}}</ref><ref name="pmid15337208">{{cite journal |author=Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL |title=Cardiac rehabilitation after myocardial infarction in the community |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=5 |pages=988–96 |year=2004 |month=September |pmid=15337208|doi=10.1016/j.jacc.2004.05.062|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01142-8|accessdate=2011-12-16}}</ref><ref name="pmid11581152">{{cite journal |author=Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T |title=Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association |journal=[[Circulation]]|volume=104 |issue=14 |pages=1694–740 |year=2001 |month=October |pmid=11581152 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11581152|accessdate=2011-12-16}}</ref><ref name="pmid12909570">{{cite journal |author=Thompson PD|title=Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease |journal=[[Arteriosclerosis, Thrombosis, and Vascular Biology]] |volume=23|issue=8 |pages=1319–21 |year=2003 |month=August |pmid=12909570|doi=10.1161/01.ATV.0000087143.33998.F2 |url=http://atvb.ahajournals.org/cgi/pmidlookup?view=long&pmid=12909570 |accessdate=2011-12-16}}</ref><ref name="pmid16263889">{{cite journal|author=Clark AM, Hartling L, Vandermeer B, McAlister FA |title=Meta-analysis: secondary prevention programs for patients with coronary artery disease |journal=[[Annals of Internal Medicine]]|volume=143 |issue=9 |pages=659–72 |year=2005 |month=November |pmid=16263889 |doi= |url=|accessdate=2011-12-16}}</ref><ref name="pmid17903645">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Bonow RO, Estes NA, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=50|issue=14 |pages=1400–33 |year=2007 |month=October |pmid=17903645 |doi=10.1016/j.jacc.2007.04.033|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)01339-3|accessdate=2011-12-16}}</ref><ref name="pmid18277195">{{cite journal |author=Walther C, Möbius-Winkler S, Linke A, Bruegel M, Thiery J, Schuler G, Halbrecht R |title=Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease |journal=[[European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology]] |volume=15 |issue=1 |pages=107–12 |year=2008 |month=February |pmid=18277195|doi=10.1097/HJR.0b013e3282f29aa6 |url=http://cpr.sagepub.com/cgi/pmidlookup?view=long&pmid=18277195|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
==2011 ACCF/AHA/SCAI Guideline Recommendations: Quality and Performance 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>==
===Quality and Performance===
<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>
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Every PCI program should operate a quality-improvement program that routinely
:'''i.''' reviews quality and outcomes of the entire program; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
:'''ii.''' reviews results of individual operators; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
:'''iii.''' includes risk adjustment; ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
:'''iv.''' provides peer review of difficult or complicated cases; and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
:'''v.''' performs random case reviews. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Every PCI program should participate in a regional or national PCI registry for the purpose of benchmarking its outcomes against current national norms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Certification and Maintenance of Certification===
<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>
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable for all physicians who perform PCI to participate in the American Board of Internal Medicine interventional cardiology board certification and maintenance of certification program. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Operator and Institutional Competency and Volume===
<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>
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Elective/urgent PCI should be performed by operators with an acceptable annual volume (greater than or equal to 75 procedures) at high-volume centers (more than 400 procedures) with on-site [[cardiac surgery]].<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH |title=Volume-outcome relationships for percutaneous coronary interventions in the stent era |journal=[[Circulation]]|volume=112 |issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref><ref name="pmid20511324">{{cite journal|author=Post PN, Kuijpers M, Ebels T, Zijlstra F |title=The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis |journal=[[European Heart Journal]]|volume=31 |issue=16 |pages=1985–92 |year=2010 |month=August |pmid=20511324|doi=10.1093/eurheartj/ehq151 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20511324 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Elective/urgent PCI should be performed by operators and institutions whose current risk-adjusted outcomes statistics are comparable to those reported in contemporary national data registries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] for [[STEMI]] should be performed by experienced operators who perform more than 75 [[ST elevation myocardial infarction primary percutaneous coronary intervention|elective PCI]] procedures per year and, ideally, at least 11 [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCI]] procedures for [[STEMI]] per year. Ideally, these procedures should be performed in institutions that perform more than 400 [[ST elevation myocardial infarction primary percutaneous coronary intervention|elective PCIs]] per year and more than 36 [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] procedures for[[STEMI]] per year.<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH |title=Volume-outcome relationships for percutaneous coronary interventions in the stent era |journal=[[Circulation]] |volume=112|issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref><ref name="pmid10865271">{{cite journal|author=Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, Gore JM, Weaver WD, Rogers WJ, Tiefenbrunn AJ |title=Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction |journal=[[JAMA :the Journal of the American Medical Association]] |volume=283 |issue=22 |pages=2941–7 |year=2000|month=June |pmid=10865271 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=10865271 |accessdate=2011-12-16}}</ref><ref name="pmid10824077">{{cite journal|author=Canto JG, Every NR, Magid DJ, Rogers WJ, Malmgren JA, Frederick PD, French WJ, Tiefenbrunn AJ, Misra VK, Kiefe CI, Barron HV |title=The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators|journal=[[The New England Journal of Medicine]] |volume=342 |issue=21 |pages=1573–80 |year=2000|month=May |pmid=10824077 |doi=10.1056/NEJM200005253422106|url=http://dx.doi.org/10.1056/NEJM200005253422106 |accessdate=2011-12-16}}</ref><ref name="pmid19215830">{{cite journal |author=Srinivas VS, Hailpern SM, Koss E, Monrad ES, Alderman MH|title=Effect of physician volume on the relationship between hospital volume and mortality during primary angioplasty |journal=[[Journal of the American College of Cardiology]] |volume=53 |issue=7|pages=574–9 |year=2009 |month=February |pmid=19215830 |doi=10.1016/j.jacc.2008.09.056|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03799-6|accessdate=2011-12-16}}</ref><ref name="pmid11684626">{{cite journal |author=Vakili BA, Kaplan R, Brown DL |title=Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in New York state |journal=[[Circulation]] |volume=104 |issue=18|pages=2171–6 |year=2001 |month=October |pmid=11684626 |doi=|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11684626|accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' It is not recommended that elective/urgent PCI be performed by low-volume operators (75 procedures per year) at low-volume centers (200 to 400 procedures per year) with or without on-site [[cardiac surgery]]. 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.<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH|title=Volume-outcome relationships for percutaneous coronary interventions in the stent era|journal=[[Circulation]] |volume=112 |issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable that operators with acceptable volume (75 PCI procedures per year) perform elective/urgent PCI at low-volume centers (200 to 400 PCI procedures per year) with on-site[[cardiac surgery]].<ref name="pmid16103238">{{cite journal |author=Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH |title=Volume-outcome relationships for percutaneous coronary interventions in the stent era |journal=[[Circulation]] |volume=112|issue=8 |pages=1171–9 |year=2005 |month=August |pmid=16103238|doi=10.1161/CIRCULATIONAHA.104.528455 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16103238 |accessdate=2011-12-16}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable that low-volume operators (75 PCI procedures per year) perform elective/urgent PCI at high-volume centers (more than 400 PCI procedures per year) with on-site cardiac surgery. Ideally, operators with an annual procedure volume of fewer than 75 procedures per year 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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The benefit of [[ST elevation myocardial infarction primary percutaneous coronary intervention|primary PCI]] for [[STEMI]] patients eligible for [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolysis]] when performed by an operator who performs fewer than 75 procedures per year (11 [[ST elevation myocardial infarction primary percutaneous coronary intervention|PCIs]] for [[STEMI]] per year) is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
==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="pmid22070834">{{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. 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=e44–122 |year=2011 |month=December |pmid=22070834 |doi=10.1016/j.jacc.2011.08.007 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02876-2 |accessdate=2012-03-16}}</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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[[Category:Up-To-Date cardiology]]
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