Chronic stable angina revascularization percutaneous coronary intervention indications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Indications

ACCF/AHA 2011 Guidelines for PCI in patients with Stable Ischemic Heart Disease (SIHD)[1] (DO NOT EDIT)

Patients With Asymptomatic Ischemia or CCS Class I or II Angina[1]
Class III
"1. PCI is not recommended in patients with asymptomatic ischemia or CCS class I or II angina who do not meet the criteria as listed under the class II recommendations or who have 1 or more of the following:
a. Only a small area of viable myocardium at risk, (Level of Evidence: C)
b. No objective evidence of ischemia. (Level of Evidence: C)
c. Lesions that have a low likelihood of successful dilatation. (Level of Evidence: C)
d. Mild symptoms that are unlikely to be due to myocardial ischemia. (Level of Evidence: C)
e. Factors associated with increased risk of morbidity or mortality. (Level of Evidence: C)
f. Left main disease and eligibility for CABG. (Level of Evidence: C)
g. Insignificant disease (less than 50% coronary stenosis). (Level of Evidence: C)"
Class IIa

"1. PCI is reasonable in patients with asymptomatic ischemia or CCS class I or II angina and with 1 or more significant lesions in 1 or 2 coronary arteries suitable for PCI with a high likelihood of success and a low risk of morbidity and mortality. The vessels to be dilated must subtend a moderate to large area of viable myocardium or be associated with a moderate to severe degree of ischemia on noninvasive testing. (Level of Evidence: B)"

"2. PCI is reasonable for patients with asymptomatic ischemia or CCS class I or II angina, and recurrent stenosis after PCI with a large area of viable myocardium or high-risk criteria on noninvasive testing. (Level of Evidence: C)"

"3. Use of PCIis reasonable in patients with asymptomatic ischemia or CCS class I or II angina with significant left main CAD (greater than 50% diameter stenosis) who are candidates for revascularization but are not eligible for CABG. (Level of Evidence: B)"

Class IIb

"1. The effectiveness of PCI for patients with asymptomatic ischemia or CCS class I or II angina who have 2- or 3-vessel disease with significantproximal LAD CAD who are otherwise eligible for CABG with 1 arterial conduit and who have treated diabetes or abnormal LV function is not well established. (Level of Evidence: B)"

"2. PCI might be considered for patients with asymptomatic ischemia or CCS class I or II angina with non-proximal LAD CAD that subtends a moderate area of viable myocardium and demonstrates ischemia on noninvasive testing. (Level of Evidence: C)"

Patients With CCS Class III Angina[1]
Class III

"1. PCI is not recommended for patients with CCS class III angina with single-vessel or multivessel CAD, no evidence of myocardial injury or ischemia on objective testing, and no trial of medical therapy, or who have 1 of the following:

a. Only a small area of myocardium at risk. (Level of Evidence: C)
b. All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. (Level of Evidence: C)
c. Ahigh risk of procedure-related morbidity or mortality. (Level of Evidence: C)
d. Insignificant disease (less than 50% coronary stenosis). (Level of Evidence: C)
e. Significant left main CAD and candidacy for CABG. (Level of Evidence: C)"
Class IIa

"1. It is reasonable that PCI be performed in patients with CCS class III angina and single-vessel or multi-vessel CAD who are undergoingmedical therapy and who have 1 or more significant lesions in 1 or more coronary arteries suitable for PCI with a high likelihood of success and low risk of morbidity or mortality. (Level of Evidence: B)"

"2. It is reasonable that PCI be performed in patients with CCS class III angina with single-vessel or multi-vessel CAD who are undergoing medical therapy with focal saphenous vein graft lesions or multiple stenoses who are poor candidates for reoperative surgery. (Level of Evidence: C)"

"3. Use of PCI is reasonable in patients with CCS class III angina with significant left main CAD (greater than 50% diameter stenosis) who are candidates for revascularization but are not eligible for CABG. (Level of Evidence: B)"

Class IIb

"1. PCI may be considered in patients with CCS class III angina with single-vessel or multivessel CAD who are undergoing medical therapy and who have 1 or more lesions to be dilated with a reduced likelihood of success. (Level of Evidence: B)"

"2. PCI may be considered in patients with CCS class III angina and no evidence of ischemia on noninvasive testing or who are undergoingmedical therapy and have 2- or 3-vessel CADwith significant proximal LAD CAD and treated diabetes or abnormal LV function. (Level of Evidence: B)"

Revascularization to Improve Survival: Non-Left Main Coronary Artery Disease[2]
Class I

"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 (Level of Evidence: B) [3][4][5]; PCI (Level of Evidence: C) [3])"

Class III (Harm)

"1. CABG or PCI should not be performed with the primary or sole intent to improve survival in patients with stable ischemic heart disease with 1 or more coronary stenoses that are not anatomically or functionally significant (e.g., greater than 70% diameter non–left main coronary artery stenosis, fractional flow reserve 0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. [6][7][8][9][10][11][12][13][14](Level of Evidence: B)"

Class IIa

"1. It is reasonable to choose CABG over PCI to improve survival in patients with complex 3-vessel CAD (e.g., SYNTAX score greater than 22) with or without involvement of the proximal LAD artery who are good candidates for CABG. [15][16][17][18][19] (Level of Evidence: B)"

"2. CABG is probably recommended in preference to PCI to improve survival in patients with multivessel CAD and diabetes mellitus, particularly if a left internal mammary artery graft can be anastomosed to the LAD artery. [20][21][22][23][19][24][25][26][27] (Level of Evidence: B)"

Class IIb

"1. The usefulness of PCI to improve survival is uncertain in patients with 2- or 3-vessel CAD (with or without involvement of the proximal LAD artery) or 1-vessel proximal LAD disease. [28][7][15][29] (Level of Evidence: B)"

"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. [30][31][32][33][34][35][36][37][38] (Level of Evidence: B)"

  • In patients with objective large ischemia associated with severe angina, PCI has shown to significantly reduce mortality and provide greater symptomatic improvement. However, on the contrary, patients with mild symptoms do not benefit from PCI.[42][43][44]

Supportive Trial Data

  • The ACIP study, a randomized study of 558 patients with increased cardiac events, compared the 12-week efficacy of three treatment strategies such as medical therapy, medical therapy plus ambulatory ECG monitoring or revascularization to suppress cardiac ischemia. The goal of the study was to assess the feasibility of a prognosis trial in patients with asymptomatic cardiac ischemia, demonstrated both stress-inducible ischemia and two or more ischemic episodes on holter monitoring.[48] Two years after randomization (1997), the total mortality was significantly reduced from 6.6% in the angina-guided strategy to 4.4% in the ischemia-guided strategy and 1.1% in the revascularization strategy (p=less than 0.02). The rate of composite primary end-points was also significantly reduced from 41.8% in the angina-guided strategy to 38.5% in the ischemia-guided strategy and 23.1% in the revascularization strategy (p=less than 0.001). Researchers concluded that a strategy of initial revascularization appeared to improve the prognosis but longer-term study was needed to further establish this relationship. [49][49]
  • The TIME study (2004) assessed the long-term survival and quality of life in 276 elderly patients with CCS class II or greater angina receiving atleast two anti-anginal medication at baseline. The study demonstrated similar long-term survival benefits observed in both the groups; however, freedom from major cardiovascular events remained higher in invasive therapy group versus the medical therapy group (39% versus 20%, p=less than 0.0001). Irrespective of whether patients were catheterized initially or only after failure to respond to medical therapy, their survival rates were better if they were revascularized within the first year.[50]
  • The GISSOC trial (2003) studied the benefit of stent implantation over balloon PTCA for the treatment of chronic total coronary occlusions in six-year clinical follow-up patients. The study demonstrated a significant reduction in the major adverse cardiovascular events observed in the stent group during a 6-year follow-up (76.1% in the stent group versus 60.4% in the PTCA group; p=0.055) and attributed this reduction secondary to the target lesion revascularization free-survival rate (85.1% in the stent group versus 65.5% in the PTCA group; p=0.0165). However, in most cases, restenosis of the study occlusion was evident at nine-month angiography. Thus, the study concluded stent implantation was superior to balloon PTCA in chronic total occlusions that can be recanalized percutaneously and is a valuable long-term therapeutic option; however, at nine-month follow-up both the stent and PTCA results appear to remain stable.[51]
  • Similar benefits with stent implantation for chronic total occlusion were reported in few other studies such as:
  • The SICCO trial (1996) reported a significant reduction in the target lesion revascularization (22% in the stent group versus 42% in the PTCA group; p=0.025) and restenosis (32% patients with stent and 74% patients with PTCA only; p=0.025) noted in the stent implantation group.[52]
  • The TOSCA study (1999) demonstrated stent implantation significantly improved late patency and reduced the rates of restenosis (70% in the PTCA group versus 55% in the stent group; p=less than 0.01) and target-vessel revascularization (15.4% in the PTCA group versus 8.4% in the stent group; p=0.03). Hence, the study concluded stent implantation being superior to PTCA for non-acute coronary occlusions.[53]
  • The SARECCO trial (1999) demonstrated a significant event free survival in the stent group observed during a 2-year follow-up (26% in the group that received angioplasty alone versus 52% in the stent group; p=less than 0.05).[54]
  • The SPACTO trial (1999) demonstrated significant reduction in the rates of restenosis (29% in the stent group versus 72% in the PTCA group; p=less than 0.01) and reocclusion (3% in the stent group versus 24% in the PTCA group) observed in the stent group. At follow-up,there was also a significant reduction in cardiac events (p=less than 0.03) and marked improvement in the anginal class (p=less than 0.01) reported in the stent group.[55]
  • The STOP study (2000) demonstrated significant reduction in the rate of restenosis (42.1% in the stent group versus 70.9% in the PTCA group; p=0.034) and reocclusion (7.9% in the stent group versus 16.1% in the PTCA group) observed with the stent implantation. However, stent group was associated with more a diffuse in-stent restenosis in comparison to a focal re-stenosis in the PTCA group that occurred at the point of total obstruction (within 5mm).[56]
  • The PRISON study (2004) demonstrated a statistically significant reduction in the need for target lesion revascularization (29% in the PTCA group versus 13% in the stent group; p=less than 0.0001) and a non-significant rate of restenosis was observed (33% in the PTCA group versus 22% in the stent group; p=0.137).[57]
  • In the PACTO study (2004), 48 consecutive patients received paclitaxel-eluting stent implantation after successful recanalization of a chronic total occlusion, researchers assessed the efficacy of drug-eluting stent in comparison to bare metal stent for the treatment of chronic total coronary occlusions. At 1-year follow-up, the incidence of major adverse cardiovascular events was significantly reduced in the paclitaxel group (12.5% in the Taxus group and 47.9% in the BMS group; p=less than 0.001) which was secondary to reduced need for repeat revascularization. The secondary end-points included the rate of restenosis (8.3% in the Taxus group and 51.1% in the BMS group; p=less than 0.001) and reocclusion (2.1% in the Taxus group and 23.4% in the BMS group; p=less than 0.005) which was also significantly reduced in the paclitaxel group. Thus, the study concluded, paclitaxel-eluting stent drastically reduced the incidence of major cardiovascular events and restenosis, and almost eliminated reocclusion, frequently observed with bare metal stents when used for chronic total occlusion.[58]
  • The AWESOME trial and registry (2004) demonstrated the benefit of PCI over CABG in patients with refractory ischemia and who are at increased risk of adverse events, which may also be applicable to patients with left ventricular dysfunction.[59][60]
  • In a sub-study (2002) of patients with prior CABG, the three-year survival rate between CABG and PCI groups did not differ significantly: 73% in the CABG group and 76% in the PCI group (p=NS). However, the patient choice registry reported that the patients with prior-CABG preferred PCI over repeat CABG.[61]

References

  1. ↑ 1.0 1.1 1.2 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 (2009). "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 of the American College of Cardiology. 54 (23): 2205–41. doi:10.1016/j.jacc.2009.10.015. PMID 19942100. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  2. ↑ 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 (2011). "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" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Borger van der Burg AE, Bax JJ, Boersma E, Bootsma M, van Erven L, van der Wall EE, Schalij MJ (2003). "Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital". The American Journal of Cardiology. 91 (7): 785–9. PMID 12667561. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  4. ↑ Every NR, Fahrenbruch CE, Hallstrom AP, Weaver WD, Cobb LA (1992). "Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest". Journal of the American College of Cardiology. 19 (7): 1435–9. PMID 1593036. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  5. ↑ Kaiser GA, Ghahramani A, Bolooki H, Vargas A, Thurer RJ, Williams WH, Myerburg RJ (1975). "Role of coronary artery surgery in patients surviving unexpected cardiac arrest". Surgery. 78 (6): 749–54. PMID 1081278. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. ↑ Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R (1994). "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". Lancet. 344 (8922): 563–70. PMID 7914958. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  7. ↑ 7.0 7.1 Jones RH, Kesler K, Phillips HR, Mark DB, Smith PK, Nelson CL, Newman MF, Reves JG, Anderson RW, Califf RM (1996). "Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease". The Journal of Thoracic and Cardiovascular Surgery. 111 (5): 1013–25. PMID 8622299. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  8. ↑ Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, Fromm B (1998). "Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions". The Journal of Thoracic and Cardiovascular Surgery. 116 (6): 997–1004. PMID 9832692. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  9. ↑ Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003). "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". Circulation. 107 (23): 2900–7. doi:10.1161/01.CIR.0000072790.23090.41. PMID 12771008. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  10. ↑ 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 (2008). "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". Circulation. 117 (10): 1283–91. doi:10.1161/CIRCULATIONAHA.107.743963. PMID 18268144. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  11. ↑ Cashin WL, Sanmarco ME, Nessim SA, Blankenhorn DH (1984). "Accelerated progression of atherosclerosis in coronary vessels with minimal lesions that are bypassed". The New England Journal of Medicine. 311 (13): 824–8. doi:10.1056/NEJM198409273111304. PMID 6332274. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  12. ↑ Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, Koolen JJ (1996). "Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses". The New England Journal of Medicine. 334 (26): 1703–8. doi:10.1056/NEJM199606273342604. PMID 8637515. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  13. ↑ 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 (2009). "Fractional flow reserve versus angiography for guiding percutaneous coronary intervention". The New England Journal of Medicine. 360 (3): 213–24. doi:10.1056/NEJMoa0807611. PMID 19144937. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  14. ↑ Sawada S, Bapat A, Vaz D, Weksler J, Fineberg N, Greene A, Gradus-Pizlo I, Feigenbaum H (2003). "Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction". Journal of the American College of Cardiology. 42 (12): 2099–105. PMID 14680734. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  15. ↑ 15.0 15.1 Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH (2006). "Selection of surgical or percutaneous coronary intervention provides differential longevity benefit". The Annals of Thoracic Surgery. 82 (4): 1420–8, discussion 1428–9. doi:10.1016/j.athoracsur.2006.04.044. PMID 16996946. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  16. ↑ Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS (2004). "Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features". Circulation. 109 (19): 2290–5. doi:10.1161/01.CIR.0000126826.58526.14. PMID 15117846. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  17. ↑ Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH (2008). "Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease". The New England Journal of Medicine. 358 (4): 331–41. doi:10.1056/NEJMoa071804. PMID 18216353. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  18. ↑ Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A (2011). "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". European Heart Journal. 32 (17): 2125–34. doi:10.1093/eurheartj/ehr213. PMID 21697170. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  19. ↑ 19.0 19.1 Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA (2005). "Long-term outcomes of coronary-artery bypass grafting versus stent implantation". The New England Journal of Medicine. 352 (21): 2174–83. doi:10.1056/NEJMoa040316. PMID 15917382. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  20. ↑ Sorajja P, Chareonthaitawee P, Rajagopalan N, Miller TD, Frye RL, Hodge DO, Gibbons RJ (2005). "Improved survival in asymptomatic diabetic patients with high-risk SPECT imaging treated with coronary artery bypass grafting". Circulation. 112 (9 Suppl): I311–6. doi:10.1161/CIRCULATIONAHA.104.525022. PMID 16159837. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  21. ↑ "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)". Circulation. 96 (6): 1761–9. 1997. PMID 9323059. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  22. ↑ "The final 10-year follow-up results from the BARI randomized trial". Journal of the American College of Cardiology. 49 (15): 1600–6. 2007. doi:10.1016/j.jacc.2006.11.048. PMID 17433949. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  23. ↑ Banning AP, Westaby S, Morice MC, Kappetein AP, Mohr FW, Berti S, Glauber M, Kellett MA, Kramer RS, Leadley K, Dawkins KD, Serruys PW (2010). "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 of the American College of Cardiology. 55 (11): 1067–75. doi:10.1016/j.jacc.2009.09.057. PMID 20079596. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  24. ↑ Hueb W, Lopes NH, Gersh BJ, Soares P, Machado LA, Jatene FB, Oliveira SA, Ramires JA (2007). "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". Circulation. 115 (9): 1082–9. doi:10.1161/CIRCULATIONAHA.106.625475. PMID 17339566. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  25. ↑ 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 (2005). "Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England". Circulation. 112 (9 Suppl): I371–6. doi:10.1161/CIRCULATIONAHA.104.526392. PMID 16159849. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  26. ↑ 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 (2001). "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 of the American College of Cardiology. 37 (4): 1008–15. PMID 11263600. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  27. ↑ Weintraub WS, Stein B, Kosinski A, Douglas JS, Ghazzal ZM, Jones EL, Morris DC, Guyton RA, Craver JM, King SB (1998). "Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease". Journal of the American College of Cardiology. 31 (1): 10–9. PMID 9426011. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  28. ↑ Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD, Galbraith PD, Hui W, Faris P, Knudtson ML (2001). "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". American Heart Journal. 142 (1): 119–26. doi:10.1067/mhj.2001.116072. PMID 11431667. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  29. ↑ 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 (2007). "Optimal medical therapy with or without PCI for stable coronary disease". The New England Journal of Medicine. 356 (15): 1503–16. doi:10.1056/NEJMoa070829. PMID 17387127. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  30. ↑ Brener SJ, Lytle BW, Casserly IP, Ellis SG, Topol EJ, Lauer MS (2006). "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". European Heart Journal. 27 (4): 413–8. doi:10.1093/eurheartj/ehi646. PMID 16272211. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  31. ↑ Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA (2007). "Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery". International Journal of Cardiology. 119 (1): 65–72. doi:10.1016/j.ijcard.2006.07.058. PMID 17045681. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  32. ↑ Lytle BW, Loop FD, Taylor PC, Goormastic M, Stewart RW, Novoa R, McCarthy P, Cosgrove DM (1993). "The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries". The Journal of Thoracic and Cardiovascular Surgery. 105 (4): 605–12, discussion 612–4. PMID 8468995. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  33. ↑ 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 (2001). "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 of the American College of Cardiology. 38 (1): 143–9. PMID 11451264. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  34. ↑ Pfautsch P, Frantz E, Ellmer A, Sauer HU, Fleck E (1999). "[Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization]". Zeitschrift Für Kardiologie (in German). 88 (7): 489–97. PMID 10467648. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  35. ↑ Sergeant P, Blackstone E, Meyns B, Stockman B, Jashari R (1998). "First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 14 (5): 480–7. PMID 9860204. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
  36. ↑ Stephan WJ, O'Keefe JH, Piehler JM, McCallister BD, Dahiya RS, Shimshak TM, Ligon RW, Hartzler GO (1996). "Coronary angioplasty versus repeat coronary artery bypass grafting for patients with previous bypass surgery". Journal of the American College of Cardiology. 28 (5): 1140–6. doi:10.1016/S0735-1097(96)00286-0. PMID 8890807. Retrieved 2011-12-04. Unknown parameter |month= ignored (help)
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