The AHA Guidelines and Scientifi c Statements Handbook
ST-elevation myocardial infarction (STEMI) [3]
and the 2007 guidelines for unstable angina/non-
STEMI (NSTEMI) [4], and recommendations based
on these data are consistent for all three guidelines.
A new section with recommendations for the man-
agement of patients with chronic kidney disease has
been added here. The 2007 guidelines have also been
updated to include recommendations from the 2006
AHA/ACC guidelines on secondary prevention for
patients with coronary and other atherosclerotic
vascular disease [5] (see Chapter 5). The important
role of the interventional cardiologist in implement-
ing and supporting the benefi ts of these therapies is
emphasized. The following guidelines therefore
consist of the 2005 PCI guideline update as modifi ed
by the 2007 PCI focused update. The outline used
in both the 2005 guideline update and 2007 focused
update has been maintained in this chapter. Classi-
fi cation of recommendations and level of evidence
are expressed in the standard ACC/AHA format.
Guideline recommendations
Outcomes
Acute outcome: procedural complications
Class I
All patients who have signs or symptoms suggestive
of MI (myocardial infarction) during or after PCI
Fig. 6.1 Troponin I levels to predict the risk of mortality in acute coronary syndromes. Mortality rates are at 42 days (without adjustment for
baseline characteristics) in patients with acute coronary syndrome. The numbers at the bottom of each bar are the numbers of patients with
cardiac troponin I levels in each range, and the numbers above the bars are percentages. P less than 0.001 for the increase in the mortality
rate (and the risk ratio for mortality) with increasing levels of cardiac troponin I at enrollment. Reprinted with permission from Antman et al.
[6] Copyright © 1996 Massachusetts Medical Society. All rights reserved.
and those with complicated procedures should
have CK-MB (creatine kinase – MB) and troponin
I or T measured after the procedure. (Level of
Evidence: B)Class IIa
Routine measurement of cardiac biomarkers (CK-
MB and/or troponin I or T) in all patients under-
going PCI is reasonable 8 to 12 hours after the
procedure. (Level of Evidence: C)Refer to Fig. 6.1.Institutional and operator competency
Quality assurance
Class I
1 An institution that performs PCI should establish
an ongoing mechanism for valid peer review of its
quality and outcomes. Review should be conducted
both at the level of the entire program and at the
level of the individual practitioner. Quality-
assessment reviews should take risk adjustment,
statistical power, and national benchmark statis-
tics into consideration. Quality-assessment reviews
should include both tabulation of adverse event
rates for comparison with benchmark values and
case review of complicated procedures and some
uncomplicated procedures. (Level of Evidence: C)