Risk reduction after PCI

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

2007 Focused Update of the PCI Focused Update ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention (DO NOT EDIT)

Comprehensive Risk Reduction for Patients With Coronary and Other Vascular Disease After PCI (DO NOT EDIT)

Smoking (DO NOT EDIT)

“

Goal: Complete cessation, no exposure to environmental tobacco smoke

”

Class I

"1. Status of tobacco use should be asked about at every visit.(Level of Evidence: B)"

"2. Every tobacco user and family members who smoke should be advised to quit at every visit (Level of Evidence: B)"

"3. The tobacco user’s willingness to quit should be assessed (Level of Evidence: B)"

"4. The tobacco user should be assisted by counseling and developing a plan for quitting.(Level of Evidence: B)"

"5. Follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and pharmacological treatment) should be arranged.(Level of Evidence: B)"

"6. Exposure to environmental tobacco smoke at work and home should be avoided.(Level of Evidence: B)"

Blood Pressure Control (DO NOT EDIT)

“

Goal: Less than 140/90 mm Hg or less than 130/80 mm Hg if patient has diabetes or chronic kidney disease

”

Class I

"1. For patients with blood pressure greater than or equal to 140/90 mm Hg (or greater than or equal to 130/80 mm Hg for patients with diabetes or chronic kidney disease), it is recommended to initiate or maintain lifestyle modification—weight control; increased physical activity; alcohol moderation; sodium reduction; and emphasis on increased consumption of fresh fruits, vegetables, and Low-fat dairy products (Level of Evidence: B)"

"2. For patients with blood pressure greater than or equal to 140/90 mm Hg (or greater than or equal to 130/80 mm Hg for patients with diabetes or chronic kidney disease), it is useful as tolerated, to add blood pressure medication, treating initially with beta blockers and/or ACE inhibitors, with the addition of other drugs such as thiazides as needed to achieve goal blood pressure.(Level of Evidence: A)"

Lipid Management (DO NOT EDIT)

“

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 I (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)"

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)"