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American Heart Association/American College of Cardiology/Society for Cardiovascular Angiography and Interventions Joint Scientific Statement
Date:12/13/2007

l for implanting a bare-metal stent or performing a balloon angioplasty with provisional stent implantation instead of the routine use of a DES.

In addition to recommendations on stents, the update addresses the timing of PCI in certain groups of patients and various clinical settings. The update reviews research published through late 2006 on the treatment strategy of "facilitated" PCI by performing fibrinolysis immediately before being transferred for PCI. Also, the update incorporates the results of research examining whether PCI is useful and efficient for re-opening completely blocked arteries in patients with one- or two- vessel coronary artery disease who are asymptomatic without evidence of ongoing ischemia if the procedure is performed between 24 hours and 28 days after a heart attack. In this time interval, guidelines indicate that PCI is not recommended in patients with one- or two- vessel disease and a totally occluded coronary artery if they are hemodynamically and electrically stable and have no ongoing or easily provoked chest pain. However for these patients or, a patient who responds favorably to initial fibrinolysis (treatment with a clot-busting drug), some physicians might use PCI selectively for those who don't continue to do well on drug therapy alone.

Members of the writing group said the balance of evidence supports an early invasive strategy for PCI for patients with unstable angina or non-ST elevation heart attack (UA/NSTEMI), who are at moderate and higher risk, but noted one recent study suggests that in those patients who are initially stabilized on comprehensive medical therapy, PCI may be used selectively.

Thus, the guideline update says, a selective invasive strategy may be considered as an alternative treatment option in initially stabilized patients. It's important to note that this treatment strategy received a lower level recommendation than that given to early PCI is the first line of treatment for "pat
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SOURCE American Heart Association
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