European Heart Journal Advance Access originally published online on March 15, 2005
European Heart Journal 2005 26(8):804-847; doi:10.1093/eurheartj/ehi138
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Guidelines for Percutaneous Coronary Interventions
The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology
Authors/Task Force Members,* Corresponding author. Chairperson: Prof. Sigmund Silber, MD, FACC, FESC, Kardiologische Praxis und Praxisklinik, Am Isarkanal 36, 81379 München, Germany. Tel: +49 89 742 15130; fax: +49 89 742 151 31. E-mail address: sigmund@silber.com
ESC Committee for Practice Guidelines (CPG): Silvia G. Priori (Chairperson) (Italy), Maria Angeles Alonso Garcia (Spain), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), Martin Cowie (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Enrique Fernandez Burgos (Spain), John Lekakis (Greece), Bertil Lindahl (Sweden), Gianfranco Mazzotta (Italy), Keith McGregor (France), João Morais (Portugal), Ali Oto (Turkey), Otto A. Smiseth (Norway)
Document Reviewers: Jaap Deckers (CPG Review Coordinator) (The Netherlands), Jean-Pierre Bassand (France), Alexander Battler (Israel), Michel Bertrand (France), Amadeo Gibert Betriu (Spain), Dennis Cokkinos (Greece), Nicolas Danchin (France), Carlo Di Mario (Italy), Pim de Feyter (The Netherlands), Kim Fox (UK), Ciro Indolfi (Italy), Karl Karsch (UK), Manfred Niederberger (Austria), Philippe Gabriel Steg (France), Michal Tendera (Poland), Frans Van de Werf (Belgium), Freek W.A. Verheugt (The Netherlands), Petr Widimski (Czech Republic)
| The first 150 words of the full text of this article appear below. |
Summary
In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed. In early studies, there was a small survival advantage with CABG surgery compared with PCI without stenting. The addition of stents and newer adjunctive medications improved the outcome for PCI. The decision to recommend PCI or CABG surgery will be guided by technical improvements in cardiology or surgery, local expertise, and patients' preference. However, until proved otherwise, PCI should be used only with reservation in diabetics with multi-vessel disease and in patients with unprotected left main stenosis. The use of drug-eluting stents might change this situation.
Patients presenting with NSTE-ACS (UA or NSTEMI) have to be stratified first for their risk of acute thrombotic complications. A clear benefit from
Preamble
1. Introduction and definitions
1.1. Method of review
1.2. Definition of levels of recommendation
2. Indications for PCI
2.1. Indications for PCI in stable coronary artery disease
2.1.1. General indications for PCI in stable coronary artery disease
2.1.2. Indications for PCI in special subsets of stable patients
2.1.3. Provisional or elective stenting in stable CAD?
2.1.4. Troponin elevation after PCI in stable CAD
2.2. Indications for PCI in acute coronary syndromes without ST-segment elevation
2.2.1. Risk stratification in NSTE-ACS
2.2.2. Conservative, early invasive, or immediately invasive?
2.3. Indications for PCI in ACS with ST-segment elevation
2.3.1. Primary PCI
2.3.2. Facilitated PCI
2.3.3. Rescue PCI after failed thrombolysis
2.3.4. Emergency PCI in cardiogenic shock
2.3.5. Routine angiography early post thrombolysis
2.3.6. Ischaemia-driven PCI after thrombolysis
2.3.7. PCI for patients not having received reperfusion within the first 12 h
2.3.8. Minimization of time delays
3. Adjunctive medications for PCI
3.1. Acetylsalicylic acid
3.1.1. Acetylsalicylic acid in stable CAD
3.1.2. ASA in NSTE-ACS
3.1.3. ASA in STE-ACS (STEMI)
3.2. Ticlopidine and clopidogrel
3.2.1. Thienopyridines (ticlopidine/clopidogrel) in stable CAD
3.2.2. Clopidogrel in NSTE-ACS
3.2.3. Clopidogrel in STE-ACS (STEMI)
3.3. Unfractionated heparin
3.3.1. Unfractionated heparin for PCI in stable CAD
3.3.2. UFH for PCI in NSTE-ACS
3.3.3. UFH for PCI in STE-ACS (STEMI)
3.4. Low-molecular weight heparins
3.4.1. LMWHs for PCI in stable CAD
3.4.2. LMWHs for PCI in NSTE-ACS
3.4.3. LMWHs for PCI in STE-ACS (STEMI)
3.5. Glycoprotein IIb/IIIa inhibitors
3.5.1. GP IIb/IIIa inhibitors for PCI in stable CAD
3.5.2. GP IIb/IIIa inhibitors for PCI in NSTE-ACS
3.5.3. GP IIb/IIIa inhibitors for PCI in STE-ACS (STEMI)
3.6. Direct thrombin inhibitors
3.6.1. Direct thrombin inhibitors for PCI in stable CAD
3.6.2. Direct thrombin inhibitors for PCI in NSTE-ACS
3.6.3. Direct thrombin inhibitors in STE-ACS (STEMI)
4. Adjunctive devices for PCI
4.1. Intracoronary brachytherapy for in-stent restenosis
4.2. Cutting balloon
4.3. Rotablation
4.4. Directional coronary atherectomy
4.5. Embolic protection devices
4.5.1. Distal protection (blocking, filter) devices
4.5.2. Proximal protection (suction, thrombectomy) devices
4.6. Adjunctive diagnostic technology
4.6.1. Intravascular ultrasound
4.6.2. Fractional flow reserve
5. Drug-eluting stents
5.1. Vessel size, long lesions, diabetes
5.2. Stent thrombosis of DES
5.3. Indications for DES
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