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Revision as of 21:44, 15 December 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: delayed PCI

Overview

Staged PCI or delayed PCI is referred to the performance of a percutaneous coronary intervention (PCI) at a later date separate from the performance of the diagnostic catheterization or the performance of an initial PCI. Ad hoc PCI is defined as performance of the PCI procedure at the time of the diagnostic catheterization ^[1].

Guidelines Regarding Staged PCI

Performance of PCI in a non-culprit artery at the time of a ST elevation MI (STEMI) is a class III contraindication. Only 2% of interventional cardiologist would perform a PCI in a non-culprit vessel in the setting of STEMI in a patient who is hemodynamically stable ^[2]. The need for and the timing of staged PCI among patients with unstable angina (UA) or non ST elevation MI (NSTEMI) and stable angina is less clear.

Timing of a Staged PCI

STEMI

62% of interventional cardiologists recommend that the PCI of the non-culprit artery be performed more than 15 days after the STEMI ^[3].

UA / NSTEMI

There is less of a consensus regarding the optimal timing of a staged PCI among UA / NSTEMI patients. 55% of surveyed cardiologists recommend waiting > 2 weeks following the initial revascularization to perform the next PCI, while 22% recommended that the additional PCI be performed during the same hospitalization as the initial revascularization.

Stable Angina

Among patients with stable angina, 64% of surveyed cardiologist recommend waiting ≥ 15 days to perform the second PCI following the initial revascularization while 35% recommend performance of PCI within 2 weeks of the initial revascularization.

Reasons Cited by Interventional Cardiologists to Perform a Staged PCI

In descending order of importance, the following reasons were offered as reasons for staging a procedure in a survey of interventional cardiologists ^[4]:

Renal function
Accumulated contrast use
Lesion complexity
Presentation with acute coronary syndrome
Symptomatology
Cumulative fluoroscopy dose

References

↑ Ad Hoc Percutaneous Coronary Intervention: A Consensus Statement From the Society for Cardiovascular Angiography and Interventions http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CDkQFjAB&url=http%3A%2F%2Fwww.scai.org%2Fasset.axd%3Fid%3Dc985cb20-a31b-4e82-a688-2f82be854b21&ei=FD7KUMXwKKay0AHEp4CACg&usg=AFQjCNH2rTxEcgSgaigX_lYvSvML2u7E-A&bvm=bv.1355272958,d.dmQ
↑ http://interventions.onlinejacc.org/article.aspx?articleid=1112023
↑ http://interventions.onlinejacc.org/article.aspx?articleid=1112023
↑ http://interventions.onlinejacc.org/article.aspx?articleid=1112023

[1] Ad Hoc Percutaneous Coronary Intervention: A Consensus Statement From the Society for Cardiovascular Angiography and Interventions http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CDkQFjAB&url=http%3A%2F%2Fwww.scai.org%2Fasset.axd%3Fid%3Dc985cb20-a31b-4e82-a688-2f82be854b21&ei=FD7KUMXwKKay0AHEp4CACg&usg=AFQjCNH2rTxEcgSgaigX_lYvSvML2u7E-A&bvm=bv.1355272958,d.dmQ

[2] ttp://interventions.onlinejacc.org/article.aspx?articleid=1112023

[3] ttp://interventions.onlinejacc.org/article.aspx?articleid=1112023

[4] ttp://interventions.onlinejacc.org/article.aspx?articleid=1112023

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[2]

[3]

[4]

@@ Line 5: / Line 5: @@
 {{SK}} delayed PCI
 ==Overview==
-Staged PCI or delayed PCI is referred to the performance of a [[percutaneous coronary intervention]] ([[PCI]]) at a later date separate from the performance of the diagnostic catheterization or the performance of an initial PCI.  Ad hoc PCI is defined as performance of the PCI procedure at the time of the diagnostic catheterization <ref>Ad Hoc Percutaneous Coronary Intervention: A Consensus Statement From the Society for Cardiovascular Angiography and Interventionshttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CDkQFjAB&url=http%3A%2F%2Fwww.scai.org%2Fasset.axd%3Fid%3Dc985cb20-a31b-4e82-a688-2f82be854b21&ei=FD7KUMXwKKay0AHEp4CACg&usg=AFQjCNH2rTxEcgSgaigX_lYvSvML2u7E-A&bvm=bv.1355272958,d.dmQ</ref>.
+Staged PCI or delayed PCI is referred to the performance of a [[percutaneous coronary intervention]] ([[PCI]]) at a later date separate from the performance of the diagnostic catheterization or the performance of an initial PCI.  Ad hoc PCI is defined as performance of the PCI procedure at the time of the diagnostic catheterization <ref>Ad Hoc Percutaneous Coronary Intervention: A Consensus Statement From the Society for Cardiovascular Angiography and Interventions http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CDkQFjAB&url=http%3A%2F%2Fwww.scai.org%2Fasset.axd%3Fid%3Dc985cb20-a31b-4e82-a688-2f82be854b21&ei=FD7KUMXwKKay0AHEp4CACg&usg=AFQjCNH2rTxEcgSgaigX_lYvSvML2u7E-A&bvm=bv.1355272958,d.dmQ</ref>.
 ==Guidelines Regarding Staged PCI==