Percutaneous coronary intervention revascularization to improve symptoms

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Percutaneous Coronary Intervention Guidelines Microchapters

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

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

ACCF/AHA 2011 Guidelines for Percutaneous Coronary Intervention: Revascularization to Improve Symptoms (DO NOT EDIT)[1]

Class I

"1. CABG or PCI to improve symptoms is beneficial in patients with 1 or more significant (greater than 70% diameter) coronary artery stenoses amenable to revascularization and unacceptable angina despite guideline-directed medical therapy. (Level of Evidence: A)"

Class IIa

"1. CABG or PCI to improve symptoms is reasonable in patients with 1 or more significant (greater than 70% diameter) coronary artery stenoses and unacceptable angina for whom guideline-directed medical therapy cannot be implemented because of medication contraindications, adverse effects, or patient preferences. (Level of Evidence: C)"

"2. PCI to improve symptoms is reasonable in patients with previous CABG, 1 or more significant (greater than 70% diameter) coronary artery stenoses associated with ischemia, and unacceptable anginadespite guideline-directed medical therapy. (Level of Evidence: C)"

"3. It is reasonable to choose CABG over PCI to improve symptoms 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. (Level of Evidence: B)"

Class IIb

"1. 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 PCI, and unacceptable angina despite guideline-directed medical therapy. (Level of Evidence: C)"

Class III (Harm)

"1. CABG or 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 revascularization. (Level of Evidence: C)"

References

  1. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B; et al. (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". Circulation. 124 (23): 2574–609. doi:10.1161/CIR.0b013e31823a5596. PMID 22064598.

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