ACCF/AHA/SCAI guideline for percutaneous coronary artery intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Definitions for the weight of the evidence (A- C) and classes of recommendations (I- III) are provided at the end of the . Class IIb. Hybrid coronary revascularization (de. ST- Elevation Myocardial Infarction.
060768637627 0060768637627 Strings Attached, Ian Hunter 9781571104601 1571104607 Read, Write, and Talk - A Practice to Enhance Comprehension, Stephanie Harvey, Anne. Decision Making in Advanced Heart Failure A Scientific Statement From the American Heart Association.
Coronary Angiography Strategies in STEMIClass IA strategy of immediate coronary angiography with intent to perform PCI (or emergency CABG) in patients with STEMI is recommended for. Patients who are candidates for primary PCI (Aversano et al., 2. Keeley, Boura, & Grines, 2. Zijlstra et al., 1. Keeley & Grines, 2. Keeley & Hills, 2.
Balloon angioplasty or BMS should be used in patients with high bleeding risk, inability to comply with 1. DAPT, or anticipated invasive or surgical procedures within the next 1. DAPT may be interrupted (Grines et al., 2.
Park et al., 2. 00. Spertus et al., 2. Nasser, Kapeliovich, & Markiewicz, 2. Options include. Clopidogrel 6. Options include clopidogrel 7.
Mehta et al., 2. 00. Wiviott et al., 2. Wallentin et al., 2. An additional anticoagulant with anti- IIa activity should be administered because of the risk of catheter thrombosis (Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators, 2. Yusuf et al., 2. 00.
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Some recommendations and text regarding DAPT in Section 5. Postprocedural Antiplatelet Therapy. Class IAfter PCI, use of aspirin should be continued inde.
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Options include clopidogrel 7. Mehta et al., 2. 00.
Scientific Publications Database patient., (Garber G;Mazin B;), Management of invasive aspergillosis in the immunocompromised, The Medical Post, NOT IN FILE. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary artery intervention. A report of the American College of Cardiology Foundation/American Heart Association Task.
Wiviott, et al., 2. Wallentin et al., 2. Important secondary prevention measures were presented in detail in the '2. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease' (AHA et al., 2. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2. Update' (Smith et al., 2. The reader is referred to this document for detailed discussions of secondary prevention.
Quality and Performance Considerations. Quality and Performance.
Class IEvery PCI program should operate a quality- improvement program that routinely 1) reviews quality and outcomes of the entire program; 2) reviews results of individual operators; 3) includes risk adjustment; 4) provides peer review of dif. Ideally, these procedures should be performed in institutions that perform more than 4.
PCIs per year and more than 3. PCI procedures for STEMI per year (Hannan et al., . Ideally, operators with an annual procedure volume of fewer than 7. Operators who perform fewer than 7. An institution with a volume of fewer than 2. Hannan et al., . Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials.
Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective.*Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Even though randomized trials are not available, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. None provided. Coronary artery disease, including: Silent ischemic heart disease (SIHD) Unstable angina/non- ST- elevation myocardial infarction (NSTEMI) ST- elevation myocardial infarction (STEMI) Evaluation. Management. Risk Assessment. Treatment. Cardiology.
Family Practice. Geriatrics. Internal Medicine. Surgery. Physicians. To assist healthcare providers in clinical decision making by describing a range of generally acceptable approaches to the diagnosis, management, and prevention of speci. Searches were limited to studies, reviews, and other evidence conducted in human subjects and that were published in English. Key search words included but were not limited to the following: ad hoc angioplasty, angioplasty, balloon angioplasty, clinical trial, coronary stenting, delayed angioplasty, meta- analysis, percutaneous transluminal coronary angioplasty, randomized controlled trial (RCT), percutaneous coronary intervention (PCI) and angina, angina reduction, antiplatelet therapy, bare- metal stents, cardiac rehabilitation, chronic stable angina, complication, coronary bifurcation lesion, coronary calci.
Additional searches cross- referenced these topics with the following subtopics: anticoagulant therapy, contrast nephropathy, PCI- related vascular complications, unprotected left main PCI, multivessel coronary artery disease (CAD), adjunctive percutaneous interventional devices, percutaneous hemodynamic support devices, and secondary prevention. Additionally, the committee reviewed documents related to the subject matter previously published by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA). References selected and published in this document are representative and not all- inclusive. Not stated. Weighting According to a Rating Scheme (Scheme Given)Applying Classification of Recommendations and Level of Evidence Size of Treatment Effect CLASS IBenefit > > > Risk. Procedure/Treatment SHOULD be performed/administered.
CLASS IIa. Benefit > > Risk. Additional studies with focused objectives needed. IT IS REASONABLE to perform procedure/administer treatment. CLASS IIb. Benefit . Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective.*Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. A recommendation with Level of Evidence B or C does not imply that the recommendation is weak.
Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Even though randomized trials are not available, there may be a very clear clinical consensus that a particular test or therapy is useful or effective.
Review of Published Meta- Analyses. Systematic Review with Evidence Tables. To provide clinicians with a comprehensive set of data, whenever deemed appropriate or when published, the absolute risk difference and number needed to treat or harm will be provided in the guideline, along with con. The Class of Recommendation (COR) is an estimate of the size of the treatment effect considering risks versus benefits in addition to evidence and/or agreement that a given treatment or procedure is or is not useful/effective or in some situations may cause harm.
The Level of Evidence (LOE) is an estimate of the certainty or precision of the treatment effect. The writing committee reviews and ranks evidence supporting each recommendation with the weight of evidence ranked as LOE A, B, or C according to specific definitions (see the . Studies are identified as observational, retrospective, prospective, or randomized where appropriate.
For certain conditions for which inadequate data are available, recommendations are based on expert consensus and clinical experience and are ranked as LOE C. When recommendations at LOE C are supported by historical clinical data, appropriate references (including clinical reviews) are cited if available.
For issues for which sparse data are available, a survey of current practice among the clinicians on the writing committee is the basis for LOE C recommendations, and no references are cited. The schema for COR and LOE is summarized in Table 1 (see the . A new addition to this methodology is separation of the Class III recommendations to delineate if the recommendation is determined to be of . In addition, in view of the increasing number of comparative effectiveness studies, comparator verbs and suggested phrases for writing recommendations for the comparative effectiveness of one treatment or strategy versus another have been added for COR I and IIa, LOE A or B only. Expert Consensus.
Experts in the subject under consideration are selected by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) to examine subject- speci. Writing committees are asked to perform a formal literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected outcomes where such data exist. When available, information from studies on cost is considered, but data on ef.
In analyzing the data and developing recommendations and supporting text, the writing committee uses evidence- based methodologies developed by the Task Force. See the . All information on reviewers' relationship with industry was distributed to the writing committee and is published in Appendix 2 of the original guideline document. This document was approved by the American College of Cardiology Foundation Board of Trustees and the American Heart Association Science Advisory and Coordinating Committee in July 2. Society for Cardiovascular Angiography and Interventions in August 2. Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, Furberg CD, Johnson DA, Kahi CJ, Laine L, Mahaffey KW, Quigley EM, Scheiman J, Sperling LS, Tomaselli GF, ACCF/ACG/AHA. ACCF/ACG/AHA 2. 01.
ACCF/ACG/AHA 2. 00. Dec 7; 5. 6(2. 4): 2. Pub. Med. Aguirre FV, Varghese JJ, Kelley MP, Lam W, Lucore CL, Gill JB, Page L, Turner L, Davis C, Mikell FL, Stat Heart Investigators.