1st January 2005
American Heart Association
American College of Cardiology Foundation
Society for Cardiovascular Angiography and Interventions
Summary,

Source: National Guidelines Clearinghouse

GUIDELINE OBJECTIVE(S)

To make recommendations regarding the appropriate use of percutaneous coronary interventions in the treatment of patients with coronary artery disease

TARGET POPULATION

Patients with coronary artery disease

INTERVENTIONS AND PRACTICES CONSIDERED

Management/Treatment

1. Percutaneous coronary interventions (PCI), including percutaneous transluminal coronary angioplasty (PTCA), balloon expandable stents, drug-eluting stents, extraction atherectomy, directional coronary atherectomy, rotational atherectomy, rheolytic thrombectomy catheter, proximal and distal embolic protection devices, excimer laser coronary atherectomy, and local radiation devices to reduce in-stent restenosis
2. Insurance of institutional and operator competency in performing (PCI) (quality assurance programs, high-volume operators in high-volume institutions, availability of onsite cardiac surgical back-up or access to cardiac surgical back-up)
3. Antiplatelet and antithrombotic adjunctive therapies (aspirin, clopidogrel, glycoprotein IIb/IIIa Inhibitors, unfractionated heparin, low-molecular-weight heparin, bivalirudin) in patients undergoing PCI
4. Special considerations (for example, management of clinical restenosis, ad hoc PCI, PCI in the cardiac transplant patient, and restenosis after stent implantation)
5. Post-PCI management (postprocedural evaluation of ischemia, risk factor modification, exercise testing, follow-up coronary angiography)

Evaluation/Follow-up

1. Angiographic assessment
2. Use of adjunctive technologies
   • Coronary intravascular ultrasound imaging (IVUS)
   • Measurement of coronary flow velocity and coronary vasodilatory reserve
   • Measurement of coronary artery pressure and fractional flow reserve (FFR)
3. Measurement of creatine kinase-MB isoenzyme and troponins I or T

MAJOR OUTCOMES CONSIDERED

• Success rates of percutaneous coronary intervention procedures as defined by angiographic (minimum stenosis diameter reduction to <20%), procedural, and clinical criteria (relief of signs and symptoms, rate of restenosis)
• Rates of procedural complications of percutaneous coronary intervention, such as: death, myocardial infarction, emergency coronary artery bypass graft (CABG), stroke, vascular access site complications, and contrast agent nephropathy
• Long-term (5- and 10-year) survival rates and event-free survival rates