Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Risk Reduction After PCI
2007 Focused Update of the PCI Focused Update ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention (DO NOT EDIT)[1]
Comprehensive Risk Reduction for Patients With Coronary and Other Vascular Disease After PCI (DO NOT EDIT)[1]
Smoking (DO NOT EDIT)[1]
“
|
Goal: Complete cessation, no exposure to environmental tobacco smoke
|
”
|
Blood Pressure Control (DO NOT EDIT)[1]
Lipid Management (DO NOT EDIT)[1]
“
|
Goal: LDL-C substantially less than 100 mg per dL (If triglycerides are greater than or equal to 200 mg per dL, non–HDL-C should be less than 130 mg per dL.)
|
”
|
Class I
|
"1. Starting dietary therapy is recommended. Reduce intake of saturated fats (to less than 7% of total calories), trans fatty acids, and cholesterol (to less than 200 mg per day). (Level of Evidence: B)"
|
"2. Promotion of daily physical activity and weight management is recommended. (Level of Evidence: B)"
|
"3. A fasting lipid profile should be assessed in all patients and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiation of lipid-lowering medication is indicated as recommended below before discharge according to the following schedule:
- ● LDL-C should be less than 100 mg per dL. (Level of Evidence: B)
- ● Further reduction of LDL-C to less than 70 mg per dL is reasonable IIa (Level of Evidence: A)
- ● If baseline LDL-C is greater than or equal to 100 mg per dL, LDL-lowering drug therapy should be initiated. (Level of Evidence: A)
- ● If on-treatment LDL-C is greater than or equal to 100 mg per dL, intensify LDL-lowering drug therapy (may require LDL-lowering drug combination) is recommended. (Level of Evidence: A)
- ● If triglycerides are greater than or equal to 150 mg per dL or HDL-C is less than 40 mg per dL, weight management, physical activity, and smoking cessation should be emphasized (Level of Evidence: B)
- ● If triglycerides are 200 to 499 mg per dL††, non–HDL-C target should be less than 130 mg per dL (Level of Evidence: B)''"
|
"4. Therapeutic options to reduce non–HDL-C include:
- ● More intense LDL-C–lowering therapy is indicated. (Level of Evidence: B)"
|
"5. If triglycerides are greater than or equal to 500 mg per dL, therapeutic options indicated and useful to prevent pancreatitis are fibrate or niacin before LDL-lowering therapy, and treat LDL-C to goal after triglyceride-lowering therapy. Achieving a non–HDL-C of less than 130 mg per dL is recommended.I (Level of Evidence: C)"
|
Class IIa
|
"1. Adding plant stanol/sterols (2 g per day) and/or viscous fiber (greater than 10 g per day) is reasonable to further lower LDL-C.(Level of Evidence: A)"
|
"2. Therapeutic options to reduce non–HDL-C include:
- ● Niacin (after LDL-C–lowering therapy) can be beneficial. (Level of Evidence: B)
- ● Fibrate therapy (after LDL-C–lowering therapy) can be beneficial. (Level of Evidence: B)"
|
"3. A fasting lipid profile should be assessed in all patients and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiation of lipid-lowering medication is indicated as recommended below before discharge according to the following schedule:
- ● If baseline LDL-C is 70 to 100 mg per dL, it is reasonable to treat to LDL-C less than 70 mg per dL (Level of Evidence: B)"
- ● Further reduction of LDL-C to less than 70 mg per dL is reasonable IIa (Level of Evidence: A)
|
Class IIa
|
"1. It may be reasonable to encourage increased consumption of omega-3 fatty acids in the form of fish or in capsules (1 g per day) for risk reduction. For treatment of elevated triglycerides, higher doses are usually necessary for risk reduction (Level of Evidence: B)"
|
"2. A fasting lipid profile should be assessed in all patients and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiation of lipid-lowering medication is indicated as recommended below before discharge according to the following schedule:
- ● If triglycerides are 200 to 499 mg per dL††, further reduction of non–HDL-C to less than 100 mg per dL is reasonable (Level of Evidence: B)"
|
Physical Activity (DO NOT EDIT)[1]
“
|
Goal: 30 minutes 5 days per week; optimal daily
|
”
|
Weight Management (DO NOT EDIT)[1]
“
|
Goal: BMI: 18.5 to 24.9 kg/m2
Waist circumference: men less than 40 inches (102 cm), women less than 35 inches (89 cm)
|
”
|
Class I
|
"1. It is useful to assess BMI and/or waist circumference on each visit and consistently encourage weight maintenance/reduction through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated to maintain/achieve a BMI between 18.5 and 24.9 kg/m2 (Level of Evidence: B)"
|
"2. The initial goal of weight-loss therapy should be to reduce body weight by approximately 10% from baseline. With success, further weight loss can be attempted if indicated through further assessment.(Level of Evidence: B)"
|
"3. If waist circumference (measured horizontally at the iliac crest) is 35 inches (89 cm) or greater in women and 40 inches (102 cm) or greater in men, it is useful to initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated.(Level of Evidence: B)"
|
Diabetes Management (DO NOT EDIT)[1]
“
|
Goal: HbA1c less than 7%
|
”
|
Aspirin (DO NOT EDIT)[1]
Clopidogrel (DO NOT EDIT)[1]
Class I
|
"1. For all post-PCI patients who receive a DES, clopidogrel 75 mg daily should be given for at least 12 months if patients are not at high risk of bleeding. For post-PCI patients receiving a BMS, clopidogrel should be given for a minimum of 1 month and ideally up to 12 months (unless the patient is at increased risk of bleeding; then it should be given for a minimum of 2 weeks).(Level of Evidence: B)"
|
"2. For all post-PCI non-stented STEMI patients, treatment with clopidogrel should continue for at least 14 days.(Level of Evidence: B)"
|
References
Template:WH
Template:WS