2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

Abstract

Preamble…262 1. Introduction…264    1.1. Evidence Review…264   1.2. Organization of Committee and Relationships With Industry…264   1.3. Review and Approval…264 2. Patients With Unstable Angina/ Non–ST-Elevation Myocardial Infarction…264    2.1. Electrocardiogram…268       2.1.1. Comparison of Early Invasive and Initial Conservative Strategies for UA/NSTEMI…269      2.1.2. Selection for Coronary Angiography…271      2.1.3. Chronic Kidney Disease…272 3. Facilitated PCI…273 4. Rescue PCI…275 5. PCI After Fibrinolysis or for Patients Not Undergoing Primary Reperfusion…277 6. Ancillary Therapy for Patients Undergoing PCI for STEMI…278 7. Antiplatelet Therapy…278 8. Bare-Metal and Drug-Eluting Stents…281    8.1. Selection of a Bare-Metal or Drug-Eluting Stent…281 9. Secondary Prevention…283 References…288 Appendix 1…293 Appendix 2…293 A primary challenge in the development of clinical practice guidelines is keeping pace with the stream of new data upon which recommendations are based. In an effort to respond more quickly to new evidence, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has created a new “focused update” process to revise the existing guideline recommendations that are affected by evolving data or opinion. Before the initiation of this focused approach, periodic updates and revisions of existing guidelines required up to 3 years to complete. Now, however, new evidence will be reviewed in an ongoing fashion to more efficiently respond to important science and treatment trends that could have a major impact on patient outcomes and quality of care. Evidence will be reviewed at least twice a year, and updates will be initiated on an as needed basis as quickly as possible while maintaining the rigorous methodology that the ACC and AHA have developed during their more than 20 years of partnership. These updated guideline recommendations reflect a consensus of expert opinion following a thorough review primarily of late-breaking clinical trials identified through a broad-based vetting process as important to the relevant patient population and of other new …