Chronic stable angina risk stratification coronary angiography
|
Chronic stable angina Microchapters | ||
|
Classification | ||
|---|---|---|
| ||
| ||
|
Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
|
Diagnosis | ||
|
Alternative Therapies for Refractory Angina | ||
|
Discharge Care | ||
|
Guidelines for Asymptomatic Patients | ||
|
Case Studies | ||
|
Chronic stable angina risk stratification coronary angiography On the Web | ||
|
FDA on Chronic stable angina risk stratification coronary angiography | ||
|
CDC onChronic stable angina risk stratification coronary angiography | ||
|
Chronic stable angina risk stratification coronary angiography in the news | ||
|
Blogs on Chronic stable angina risk stratification coronary angiography | ||
|
to Hospitals Treating Chronic stable angina risk stratification coronary angiography | ||
|
Risk calculators and risk factors for Chronic stable angina risk stratification coronary angiography | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S.
Overview
In patients with chronic stable angina, the extent and severity of coronary artery disease (CAD), and left ventricular dysfunction remain the strongest predictors of long-term prognosis. Hence, patients identified as high risk for underlying CAD based on non-invasive testing, patients with CCS class III or IV angina and patients who are non-responsive to medical therapy are referred for coronary angiography. Coronary angiography is primarily used to assess the number and location of stenoses, of which triple-vessel disease and proximal stenoses involving the left main and proximal LAD are associated with increased mortality [1]. In patients with single-vessel disease, coronary angiography and myocardial perfusion imaging provide similar results in assessing the severity of coronary stenosis, [2] [3] [4] however, in patients with multi-vessel disease, nuclear imaging or echocardiography are more useful in evaluating the prognosis [5] [6].
ACC / AHA Guidelines- Who With Angina Should Undergo Coronary Angiography and Left Ventriculography for Risk Stratification (DO NOT EDIT)[7]
| “ |
Class I1. Patients with disabling (CCS classes III and IV) chronic stable angina despite medical therapy. (Level of Evidence: B) 2. Patients with high-risk criteria on noninvasive testing regardless of anginal severity. (Level of Evidence: B) 3. Patients with angina who have survived sudden cardiac death or serious ventricular arrhythmia. (Level of Evidence: B) 4. Patients with angina and symptoms and signs of congestive heart failure. (Level of Evidence: C) 5. Patients with clinical characteristics that indicate a high likelihood of severe CAD. (Level of Evidence: C) Class IIa1. Patients with significant LV dysfunction (ejection fraction less than 45%), CCS class I or II angina, and demonstrable ischemia but less than high-risk criteria on noninvasive testing. (Level of Evidence: C) 2. Patients with inadequate prognostic information after noninvasive testing. (Level of Evidence: C) Class IIb1. Patients with CCS class I or II angina, preserved LV function (ejection fraction more than 45%), and less than high-risk criteria on noninvasive testing. (Level of Evidence: C) Class III1. Patients with CCS class I or II angina who respond to medical therapy and have no evidence of ischemia on noninvasive testing. (Level of Evidence: C) 2. Patients who prefer to avoid revascularization. (Level of Evidence: C) |
” |
ESC Guidelines- Who With Stable Angina Should Undergo Risk Stratification by Coronary Arteriography (DO NOT EDIT)[8]
| “ |
Class I1. Patients determined to be at high risk for adverse outcome on the basis of non-invasive testing even if they present with mild or moderate symptoms of angina. (Level of Evidence: B) 2. Severe stable angina (CCS class III, particularly if the symptoms are inadequately responding to medical treatment. (Level of Evidence: B) 3. Stable angina in patients who are being considered for major non-cardiac surgery, especially vascular surgery (repair of aortic aneurysm, femoral bypass, carotid endarterectomy) with intermediate or high risk features on non-invasive testing. (Level of Evidence: B) Class IIa1. Patients with an inconclusive diagnosis on non-invasive testing, or conflicting results from different noninvasive modalities. (Level of Evidence: C) 2. Patients with a high risk of restenosis after PCI if PCI has been performed in a prognostically important site. (Level of Evidence: C) |
” |
Vote on and Suggest Revisions to the Current Guidelines
Sources
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [8]
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [7]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [9]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [10]
References
- ↑ Califf RM, Armstrong PW, Carver JR, D'Agostino RB, Strauss WE (1996)27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. J Am Coll Cardiol27 (5):1007-19. PMID: 8609316
- ↑ Serruys PW, di Mario C, Piek J, Schroeder E, Vrints C, Probst P et al. (1997)Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: the DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe). Circulation 96 (10):3369-77. PMID:9396429
- ↑ Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ et al. (1996) Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334 (26):1703-8. [1] PMID: 8637515
- ↑ Kern MJ, Donohue TJ, Aguirre FV, Bach RG, Caracciolo EA, Wolford T et al. (1995) Clinical outcome of deferring angioplasty in patients with normal translesional pressure-flow velocity measurements. J Am Coll Cardiol 25 (1):178-87. PMID: 7798498
- ↑ Chamuleau SA, Tio RA, de Cock CC, de Muinck ED, Pijls NH, van Eck-Smit BL et al. (2002)Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease. J Am Coll Cardiol 39 (5):852-8. PMID: 11869852
- ↑ Miller DD (2002)Coronary flow studies for risk stratification in multivessel disease. A physiologic bridge too far? J Am Coll Cardiol 39 (5):859-63. PMID:11869853
- ↑ 7.0 7.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. PMID: 10351980
- ↑ 8.0 8.1 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
- ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758
- ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462