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Chest Pain / Angina Pectoris: Difference between revisions
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<small>Data from Gibbons, RJ, Abrams, J, Chatterjee, K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 2003; 107:149.</small> | <small>Data from Gibbons, RJ, Abrams, J, Chatterjee, K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 2003; 107:149.</small> | ||
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===temp table=== | |||
{| class="wikitable" border="1" style="width: 700px" | |||
|- | |||
! style="background: #34abff; color: white; " | Class of recommendations | |||
! style="background: #34abff; color: white" | ACC AHA consider primary PCI | |||
|- | |||
| style="background: #74fb3f; vertical-align:top;" | '''Class I''' | |||
| style="background: white" | There is evidence and/or general agreement that primary PCI for reperfusion therapy should be performed in patients with STEMI (including true posterior MI or MI with new or presumably new left bundle branch block) in the following settings: | |||
*General considerations: | |||
:#If immediately available, primary PCI of the infarct-related artery should be performed when the procedure can be initiated within 12 hours of symptom onset and in a timely fashion (balloon inflation within 90 minutes of presentation) by skilled operators (individuals who perform more than 75 PCI procedures per year). | |||
:#The procedure should be supported by experienced personnel in an appropriate laboratory environment, defined as a laboratory that performs more than 200 PCI procedures per year, of which at least 36 are primary PCI for STEMI, and has cardiac surgery capability. | |||
*Specific considerations: | |||
:#With each of the following indications, primary PCI should be performed as quickly as possible with a goal of a medical contact-to-balloon or door-to-balloon interval of 90 minutes or less. | |||
:#If the symptom duration is within three hours and the expected door-to-balloon time minus the expected door-to-needle time for fibrinolytic therapy is: | |||
:::a. Within one hour, primary PCI is generally preferred. | |||
:::b. Greater than one hour, fibrinolytic therapy with a fibrin-specific agent is generally preferred. | |||
<li value="4">If the symptom duration is greater than three hours, primary PCI is generally preferred. | |||
<li value="5">Primary PCI should be performed in patients less than 75 years of age who develop shock within 36 hours of MI and are suitable for revascularization that can be performed within 18 hours of shock unless further support is futile because of the patient's wishes or contraindications or unsuitability for further invasive care. | |||
<li value="6">Primary PCI should be performed in patients with severe HF and/or pulmonary edema (Killip class 3) and symptom onset within 12 hours. | |||
|- | |||
| style="background: #fdaa02; vertical-align:top;" | '''Class IIa''' | |||
| style="background: white" | The evidence/opinion is in favor of the efficacy of primary PCI for reperfusion therapy in patients with STEMI (including true posterior MI or MI with new or presumably new left bundle branch block) in the following settings: | |||
*Selected patients ≥75 years of age who develop shock within 36 hours of MI and are suitable for revascularization that can be performed within 18 hours of shock. Criteria for selection include good prior functional status, suitability for revascularization, and patient agreement to invasive therapy. | |||
*Patients seen within 12 to 24 hours of symptom onset who have one or more of the following features: severe heart failure; hemodynamic or electrical instability; and/or evidence of persistent ischemia. | |||
|- | |||
| style="background: #fdaa02; vertical-align:top;" | '''Class IIb''' | |||
| style="background: white" | The evidence/opinion is less well established for the efficacy of primary PCI for reperfusion therapy in patients with STEMI (including true posterior MI or MI with new or presumably new left bundle branch block) in the following setting: | |||
*Among patients who are eligible for fibrinolysis, performance of primary PCI by an operator who does less than 75 PCI procedures per year. | |||
|- | |||
| style="background: #fd3535; vertical-align:top;" | '''Class III''' | |||
| style="background: white" | There is evidence and/or general agreement that primary PCI for reperfusion therapy in patients with STEMI (including true posterior MI or MI with new or presumably new left bundle branch block) may not be useful and, in some cases, may be harmful in the following settings: | |||
#Primary PCI should NOT be performed in asymptomatic patients who present more than 12 hours after symptom onset who are hemodynamically and electrically stable. | |||
#Among patients undergoing primary PCI who do not have hemodynamic compromise, concurrent elective PCI in a non-infarct-related artery should NOT be performed. | |||
|- | |||
| colspan="2" | | |||
<small>Data from: Antman, EM, Anbe, DT, Armstrong, PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004; 110:588; and Smith, SC Jr, Feldman, TE, Hirshfeld, JW Jr, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47:e1.</small> | |||
|} | |} | ||