The AHA Guidelines and Scientific Statements Handbook

Percutaneous Coronary Intervention

Sidney C. Smith, Jr.

6

Organization and evidence
Changes since publication of the 2005 guidelines
for PCI
Guideline recommendations
Outcomes
Acute outcome: procedural complications
Institutional and operator competency
Quality assurance
Operator and institutional volume
Role of on-site cardiac surgical backup
Primary PCI for STEMI without on-site cardiac
surgery
Elective PCI without on-site surgery
Indications
Patients with asymptomatic ischemia or Canadian
Cardiovascular Society (CCS) class I or II
angina
Patients with CCS class III angina
Patients with unstable angina (UA)/NSTEMI
Patients with STEMI
Percutaneous intervention in patients with prior
coronary bypass surgery
Management of patients undergoing PCI
Evolutions of technologies
Antiplatelet and antithrombotic adjunctive therapies
for PCI
Post-PCI management
Special considerations
Clinical restenosis: background and management
Chronic kidney disease
Comparison with other guidelines
Ongoing research efforts and future directions

Organization and evidence

Coronary heart disease (CHD) is the leading cause

of death in the United States, and coronary revascu-

larization with percutaneous coronary intervention

(PCI) is an important and frequently performed

therapy for this condition. In 2005, a writing group

composed of representatives from the American

College of Cardiology (ACC), American Heart Asso-

ciation (AHA), and Society for Cardiovascular Angi-

ography and Interventions (SCAI) compiled an

update of the 2001 ACC/AHA guidelines for PCI.

The update [1] features recommendations driven by

advances in stent design, including the introduction

of drug-eluting stents (DES), as well as evidence on

the use of adjunctive therapy with glycoprotein (GP)

IIb/IIIa receptor antagonists, bivalirudin, and thi-

enopyridines. In addition, important recommenda-

tions are made regarding the indication for and

timing of PCI for the treatment of patients with

acute coronary syndromes and the need for regular

ongoing institutional and operator quality assess-

ment. Special sections were presented that discussed

angiographic predictors of success/complications,

women, the elderly, diabetes mellitus, and compari-

sons with coronary bypass surgery [1].

Changes since publication of the 2005

Guidelines for PCI

In 2007, a focused update on PCI2 was compiled by

the ACC/AHA/SCAI writing group, which made

recommendations based on a review of evidence

from clinical trials presented after the 2005 PCI

update. Many of these trials were also considered

in the 2007 ACC/AHA focused update on

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978 -1-405-18463-2