This is the current release of the guideline.

This guideline updates a previous version: Smith SC, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines). J Am Coll Cardiol 2001 Jun;37(8):2239i-lxvi.

Coronary artery disease, including:

• Asymptomatic ischemia or Canadian Cardiovascular Society (CCS) class I or II angina
• CCS class III angina
• Unstable angina/non-ST-elevation myocardial infarction (NSTEMI)
• ST-elevation myocardial infarction (STEMI)
• Ischemia (early or late) after coronary artery bypass graft

Evaluation
Management
Treatment

Cardiology
Family Practice
Geriatrics
Internal Medicine
Surgery

Physicians

2005 Guideline

To make recommendations regarding the appropriate use of percutaneous coronary interventions in the treatment of patients with coronary artery disease

2007 Focused Update

To revise the 2005 guideline recommendations that are affected by evolving data and opinion

Patients with coronary artery disease

Management/Treatment

1. Percutaneous coronary interventions (PCI), including percutaneous transluminal coronary angioplasty (PTCA), balloon expandable stents, drug-eluting stents, extraction atherectomy, directional coronary atherectomy, rotational atherectomy, rheolytic thrombectomy catheter, proximal and distal embolic protection devices, excimer laser coronary atherectomy, and local radiation devices to reduce in-stent restenosis
2. Insurance of institutional and operator competency in performing PCI (quality assurance programs, high-volume operators in high-volume institutions, availability of onsite cardiac surgical back-up or access to cardiac surgical back-up)
3. Antiplatelet and antithrombotic adjunctive therapies (aspirin, clopidogrel, glycoprotein IIb/IIIa Inhibitors, unfractionated heparin, low-molecular-weight heparin, bivalirudin) in patients undergoing PCI
4. Special considerations (for example, management of clinical restenosis, ad hoc PCI, PCI in the cardiac transplant patient, and restenosis after stent implantation)
5. Post-PCI management (postprocedural evaluation of ischemia, risk factor modification, exercise testing, follow-up coronary angiography)

Evaluation/Follow-up

1. Angiographic assessment
2. Use of adjunctive technologies
   • Coronary intravascular ultrasound imaging (IVUS)
   • Measurement of coronary flow velocity and coronary vasodilatory reserve
   • Measurement of coronary artery pressure and fractional flow reserve (FFR)
3. Measurement of creatine kinase-MB isoenzyme and troponins I or T

• Success rates of percutaneous coronary intervention procedures as defined by angiographic (minimum stenosis diameter reduction to <20%), procedural, and clinical criteria (relief of signs and symptoms, rate of restenosis)
• Rates of procedural complications of percutaneous coronary intervention, such as: death, myocardial infarction, emergency coronary artery bypass graft (CABG), stroke, vascular access site complications, and contrast agent nephropathy
• Long-term (5- and 10-year) survival rates and event-free survival rates

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases

2005 Guideline

The committee conducted comprehensive searching of the scientific and medical literature on percutaneous coronary intervention (PCI), with special emphasis on randomized controlled trials and meta-analyses published since 2001. In addition to broad-based searching on PCI, specific targeted searches were performed on the following subtopics: catheter-based intervention, stents (drug-eluting and bare-metal), cardiac biomarkers (e.g., creatine kinase and troponins), pharmacological therapy (aspirin, thienopyridines, GP IIb/IIIa inhibitors, heparin, and direct thrombin inhibitors), special populations (women, patients with diabetes, elderly), coronary artery bypass grafting (CABG), high-risk PCI, quality, outcomes, volume, left main PCI (protected and unprotected), distal embolic protection, intravascular ultrasound (IVUS), fractional flow reserve (FFR), vascular closure, and secondary prevention/risk factor modification. The complete list of keywords is beyond the scope of this section. The committee reviewed all compiled reports from computerized searches and conducted additional searching by hand. Literature citations were generally restricted to published manuscripts appearing in journals listed in Index Medicus. Because of the scope and importance of certain ongoing clinical trials and other emerging information, published abstracts were cited when they were the only published information available. Additionally, the Committee reviewed and incorporated recommendations and/or text from published American College of Cardiology/American Heart Association (ACC/AHA) or Society for Cardiovascular Angiography and Interventions (SCAI) documents to maintain consistency, as appropriate.

2007 Focused Update

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 data deemed to have an impact on patient. It is important to note that this focused update is not intended to represent an update based on a full literature review from the date of the previous guideline publication. Specific criteria/considerations for inclusion of new data include:

• Publication in a peer-reviewed journal
• Large, randomized, placebo-controlled trial(s)
• Nonrandomized data deemed important on the basis of results that impact current safety and efficacy assumptions
• Strengths/weakness of research methodology and findings
• Likelihood of additional studies influencing current findings
• Impact on current performance measure(s) and/or likelihood of the need to develop new performance measure(s)
• Requests and requirements for review and update from the practice community, key stakeholders, regulatory agencies, and other sources free of relationships with industry or other potential bias
• Number of previous trials showing consistent results
• Need for consistency with other new guidelines or guideline revisions

Evidence Review

Selected late-breaking clinical trials presented at the 2005 and 2006 annual scientific meetings of the American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology, as well as selected other data, were reviewed by the standing guideline writing committee along with the parent Task Force and other experts to identify those trials and other key data that might impact guideline recommendations. On the basis of the criteria/considerations noted above, recent trial data and other clinical information were considered important enough to prompt a focused update of the ACC/AHA/Society for Cardiovascular Angiography and Interventions (SCAI) 2005 Guideline Update for Percutaneous Coronary Intervention.

To provide clinicians with a comprehensive set of data, whenever possible, the exact event rates in various treatment arms of clinical trials are presented to permit calculation of the absolute risk difference (ARD) and number needed to treat (NNT) or harm (NNH); the relative treatment effects are described either as odds ratio (OR), relative risk (RR), or hazard ratio (HR), depending on the format in the original publication.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

2004 Guideline

Levels of Evidence

A: Data derived from multiple randomized clinical trials or meta-analyses

B: Data derived from a single randomized trial, or nonrandomized studies

C: Only consensus opinion of experts, case studies, or standard-of-care

2007 Focused Update

Applying Classification of Recommendations and Level of Evidence

*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.

NOTE: In 2003, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines developed a list of suggested phrases to use when writing recommendations. All guideline recommendations have been written in full sentences that express a complete thought, such that a recommendation, even if separated and presented apart from the rest of the document (including headings above sets of recommendations), would still convey the full intent of the recommendation. It is hoped that this will increase readers' comprehension of the guidelines and will allow queries at the individual recommendation level. (See Table 1 in the Focused Update document for a list of suggested phrases for writing recommendations.)

Meta-Analysis
Review of Published Meta-Analyses
Systematic Review with Evidence Tables

2005 Guideline

Writing groups were specifically charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered, along with frequency of follow-up and cost-effectiveness.

2007 Focused Update

In analyzing the data and developing updated recommendations and supporting text, the focused update writing group used evidence-based methodologies developed by the American College Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines, which are described elsewhere.

The schema for class of recommendation and level of evidence is summarized in Table 1 in the focused update document (see also the "Rating Scheme for the Strength of the Evidence" field in this summary), which also illustrates how the grading system provides estimates of the size of the treatment effect and the certainty of the treatment effect. Note that a recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in guidelines do not lend themselves to clinical trials. Although randomized trials may not be available, there may be a very clear clinical consensus that a particular test or therapy is useful and effective. Both the class of recommendation and level of evidence listed in the focused updates are based on consideration of the evidence reviewed in previous iterations of the guidelines as well as the focused update. Of note, the implications of older studies that have informed recommendations but have not been repeated in contemporary settings are carefully considered.

Expert Consensus

2005 Guideline

Experts in the subject under consideration are selected from the American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography and Interventions (SCAI) to examine subject-specific data and write guidelines. The process includes additional representatives from other medical specialty groups where appropriate. Writing groups are specifically charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered as well as frequency of follow-up and cost-effectiveness.

2007 Focused Update

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.

For this focused update, all members of the 2005 Percutaneous Coronary Intervention (PCI) writing committee were invited to participate; those who agreed (referred to as the 2007 focused update writing group) were required to disclose all relationships with industry (RWI) relevant to the data under consideration. Focused update writing group members who had no significant relevant RWI wrote the first draft of the focused update; the draft was then reviewed and revised by the full writing group. Each recommendation required a confidential vote by the writing group members before external review of the document. Any writing committee member with a significant (greater than $10,000) RWI relevant to the recommendation was recused from voting on that recommendation.

2005 Guideline

Class I: Conditions for which there is evidence for and/or general agreement that a given procedure or treatment is beneficial, useful, and effective

Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment

Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy.

Class IIb: Usefulness/efficacy is less well established by evidence/opinion.

Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful

2007 Focused Update

See "Rating Scheme for the Strength of the Evidence" field, above.

Among all diseases worldwide, ischemic heart disease currently ranks fifth in disability burden, and is projected to rank first by the year 2020. As healthcare delivery systems in countries with established economic markets continue to incorporate new and expensive technologies, the costs of medical care have seemingly escalated beyond the revenue historically allotted to health care. Given limited healthcare resources, a cost-effectiveness analysis is appropriate to evaluate percutaneous coronary revascularization strategies. The results of cost-effectiveness analyses for any comparable treatment are reported in terms of the incremental cost per unit of health gained, such as 1 year of life adjusted to perfect health (quality-adjusted life year, QALY) compared with the standard of care. By modeling different treatments, different patient subsets, and different levels of disease, a series of cost-effectiveness ratios may be constructed to show the tradeoffs associated with choosing among competing interventions.

Although there is no established cost-effectiveness ratio threshold, cost-effectiveness ratios of less than $20,000 per QALY (such as seen in the treatment of severe diastolic hypertension or cholesterol lowering in patients with ischemic heart disease) are considered highly favorable and consistent with well accepted therapies. Incremental cost-effectiveness ratios that range between $20,000 and $60,000 per QALY may be viewed as reasonably cost-effective and thus acceptable in most countries, whereas ratios greater than $60,000 to $80,000 may be considered too expensive for most healthcare systems. The Committee defines useful and efficacious treatments, in terms of cost-effectiveness, as treatments with acceptable or favorable cost-effectiveness ratios. Cost-effectiveness analysis is not by itself sufficient to incorporate all factors necessary for medical decision making on an individual patient basis, nor is it sufficient to dictate the broad allocation of societal resources for health care. Rather, cost-effectiveness analysis aims to serve mainly as an aid to medical decision making on the basis of comparison with other evaluated therapies.

The results of cost-effectiveness analysis in the field of percutaneous revascularization for ischemic heart disease have been derived from decision models that incorporate literature-based procedure-related morbidity and mortality, coronary disease related mortality, and estimates of the benefit of selected revascularization procedures. When available, results from randomized trials (levels of evidence A and B) are used to estimate the outcomes of each decision tree branch within the decision-analytical model, for example, using data estimating the restenosis rate after uncomplicated coronary stenting of a single, simple, lesion. Cost-effectiveness analyses have been used to compare medical therapy with percutaneous transluminal coronary angioplasty (PTCA) with coronary artery bypass graft (CABG), balloon angioplasty with coronary stenting, and routine coronary angiography following acute myocardial infarction (MI) with symptom-driven coronary angiography.

In patients with severe angina, normal left ventricle (LV) function, and single-vessel disease of the left anterior descending artery (LAD), the cost-effectiveness ratio for PTCA, directional coronary atherectomy, or coronary stenting that can be expected to provide greater than 90% success rate with less than 3% major acute complication rate is very favorable (less than $20,000 per QALY) compared to medical therapy. The rating also applies to patients with symptomatic angina or documented ischemia and 2-vessel coronary disease in which percutaneous coronary revascularization can be expected to provide a more than 90% success rate with a less than 3% major acute complication rate. In patients with 3-vessel coronary disease who have comorbidities that increase operative risk for CABG surgery, percutaneous coronary intervention (PCI) that is believed to be safe and feasible is reasonably acceptable ($20,000-$60,000 per QALY). In patients in the post-MI setting, a strategy of routine, nonsymptom-driven, coronary angiography and PCI performed for critical (greater than 70% diameter stenosis) culprit coronary lesions amenable to balloon angioplasty or stenting has been proposed to be reasonably cost-effective in many subgroups.

In patients with symptomatic angina or documented ischemia and 3-vessel coronary disease, for which bypass surgery can be expected to provide full revascularization and an acute complication rate of less than 5%, the cost-effectiveness of PCI is not well established. Although PTCA for 2- and 3-vessel coronary disease appears to be as safe, but initially less expensive than CABG surgery, the costs of PTCA converge towards the higher costs of bypass surgery after 3 to 5 years. Thus, whereas PTCA or CABG surgery has been shown to be cost-effective compared with medical therapy, there is no evidence for incremental cost-effectiveness of PTCA over bypass surgery for 2- or 3-vessel coronary disease in patients who are considered good candidates for both procedures. For patients with 1- or 2-vessel coronary disease who are asymptomatic or have only mild angina, without documented left main disease, the estimated cost-effectiveness ratios for PCI are greater than $80,000 per QALY compared with medical therapy, and are thus considered less favorable.

The initial mean cost of angioplasty was 65% that of surgery, but need for repeat interventions increased medical expenses so that after 5 years the total medical cost of PTCA was 95% that of surgery ($56,225 vs. $58,889), a significant difference of $2,664 (p = 0.047). Compared with CABG, PTCA appeared less costly for patients with 2-vessel disease, but not for patients with 3-vessel disease.

The use of drug-eluting stents (DES) is affecting the cost-effectiveness of PCI. In the SIRIUS (Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions) trial, there were 21 fewer repeat revascularization procedures per 100 patients treated with the sirolimus stent. Although the DES group's hospital costs were $2800 more, much of that was negated in follow-up by the high reintervention rate in the bare-metal stent (BMS) group. However, the number of repeat procedures in such trials with routine angiographic follow-up is inflated compared with registries of BMS, which suggests only 6 to 7 repeat procedures are avoided by routinely using DES. The ultimate cost effectiveness of drug-eluting stenting will depend on the cost of the stents, how many are implanted per patient, and how many repeat procedures are avoided.

Because cost-effectiveness analysis research is new in the field of PCI, its results are limited. The Committee underscores the need for cost containment and careful decision making regarding the use of PCI strategies.

External Peer Review
Internal Peer Review

This document was reviewed by two official reviewers nominated by the American College of Cardiology (ACC), two official reviewers nominated by the American Heart Association (AHA); two official reviewers nominated by the Society for Cardiac Angiography and Interventions (SCAI); one official reviewer from the ACC/AHA Task Force of Practice Guidelines; and eight content reviewers, including members from the AHA Committee on Diagnostic and Interventional Cardiac Catheterization and the American College of Cardiology Foundation (ACCF) Cardiac Catheterization and Intervention Committee.

2007 Focused Update

This document was reviewed by 2 outside reviewers nominated by each cosponsoring organization (ACC, AHA, and SCAI) and 24 individual content reviewers. All reviewer relationship with industry (RWI) information was collected and distributed to the writing committee and is published in the focused update document.

This focused update was approved for publication by the governing bodies of the American College of Cardiology Foundation, the AHA, and SCAI.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations" field).

Appropriate use of percutaneous coronary interventions in the treatment of patients with coronary artery disease

• Potential procedural complications of percutaneous coronary interventions (PCI) have been categorized as major (death, myocardial infarction [MI], and stroke) or minor (transient ischemic attack, access site complications, renal insufficiency, or adverse reactions to radiographic contrast). Additional specific complications include intracoronary thrombosis, coronary perforation, tamponade, and arrhythmias.
• Compared with bypass surgery, the disadvantages of percutaneous coronary intervention are early restenosis and the inability to relieve many totally occluded arteries and/or those vessels with extensive atherosclerotic disease.

Subgroups Most Likely to be Harmed

Coexistent clinical conditions can increase the complication rates for any given anatomic risk factor. For example, complications occurred in 15.4% of patients with diabetes versus 5.8% of patients without diabetes undergoing balloon angioplasty in a multicenter experience. Several studies have reported specific factors associated with increased risk of adverse outcome after percutaneous transluminal coronary angioplasty (PTCA). These factors include advanced age, female gender, unstable angina (UA), congestive heart failure (HF), diabetes, and multivessel coronary artery disease (CAD). Elevated baseline C-reactive protein (CRP) has recently also been shown to be predictive of 30-day death and MI. Other markers of inflammation, such asinterleukin-6 and other cytokines, have also been shown to be predictive of outcome.

Contraindications and Cautions for Fibrinolysis in ST-Elevation Myocardial Infarction (STEMI)*

Absolute Contraindications

• Any prior intracranial hemorrhage
• Known structural cerebral vascular lesion (e.g., indicates arteriovenous malformation [AVM])
• Known malignant intracranial neoplasm (primary or metastatic)
• Ischemic stroke within 3 months, EXCEPT acute ischemic stroke within 3 hours
• Suspected aortic dissection
• Active bleeding or bleeding diathesis (excluding menses)
• Significant closed head or facial trauma within 3 months

Relative Contraindications

• History of chronic severe, poorly controlled hypertension
• Severe uncontrolled hypertension on presentation (systolic blood pressure (SBP) greater than 180 mm Hg or diastolic blood pressure (DBP) greater than 110 mm Hg)**
• History of prior ischemic stroke greater than 3 months, dementia, or known intracranial pathology not covered in contraindications
• Traumatic or prolonged (greater than 10 minutes) cardiopulmonary resuscitation (CPR) or major surgery (less than 3 weeks)
• Recent (within 2 to 4 weeks) internal bleeding
• Noncompressible vascular punctures
• For streptokinase/anistreplase: prior exposure (more than 5 days ago) or prior allergic reaction to these agents
• Pregnancy
• Active peptic ulcer
• Current use of anticoagulants: the higher the INR, the higher the risk of bleeding

*Viewed as advisory for clinical decision making and may not be all inclusive or definitive.

**Could be an absolute contraindication in low-risk patients with STEMI

2007 Focused Update

Acute fibrinolytic therapy is contraindicated for acute coronary syndrome (ACS) patients without ST-segment elevation, except for those with electrocardiographic true posterior myocardial infarction (MI) manifested as ST-segment depression in 2 contiguous anterior precordial leads and/or isolated ST-segment elevation in posterior chest lead.

2005 Guideline

• These practice guidelines are intended to assist healthcare providers in clinical decision-making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. The guidelines attempt to define practices that meet the needs of most patients in most circumstances. These guideline recommendations reflect a consensus of expert opinion after a thorough review of the available, current scientific evidence and are intended to improve patient care. If these guidelines are used as the basis for regulatory/payer decisions, the ultimate goal is quality of care and serving the patient's best interests. The ultimate judgment regarding care of a particular patient must be made by the healthcare provider and patient in light of all of the circumstances presented by that patient.
• Percutaneous coronary intervention (PCI) is a technique that has been continually refined and modified; hence, continued periodic guideline revision is anticipated. These guidelines are to be viewed as broad recommendations to aid in the appropriate application of PCI. Under unique circumstances, exceptions may exist. These guidelines are intended to complement, not replace, sound medical judgment and knowledge. They are intended for operators who possess the cognitive and technical skills for performing PCI and assume that facilities and resources required to properly perform PCI are available.

2007 Focused Update

• The American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines address patient populations (and health care providers) residing in North America. As such, drugs that are not currently available in North America are discussed in the text without a specific class of recommendation. For studies performed in large numbers of subjects outside of North America, each writing committee reviews the potential impact of different practice patterns and patient populations on the treatment effect and on the relevance to the ACC/AHA target population to determine whether the findings should form the basis of a specific recommendation.
• The ACC/AHA practice guidelines are intended to assist health care providers in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, and prevention of specific diseases or conditions. The guidelines attempt to define practices that meet the needs of most patients in most circumstances. The ultimate judgment regarding care of a particular patient must be made by the health care provider and patient in light of all the circumstances presented by that patient. Thus, there are circumstances in which deviations from these guidelines may be appropriate. Clinical decision making should consider the quality and availability of expertise in the area where care is provided. These guidelines may be used as the basis for regulatory or payer decisions, but the ultimate goal is quality of care and serving the patient's best interests.
• Prescribed courses of treatment in accordance with these recommendations are only effective if they are followed by the patient. Because lack of patient adherence may adversely affect treatment outcomes, health care providers should make every effort to engage the patient in active participation with prescribed treatment.

An implementation strategy was not provided.

Living with Illness

Effectiveness
Timeliness

Not applicable: The guideline was not adapted from another source.

2001 Jun (revised 2005; addendum released 2008 Jan)

American College of Cardiology Foundation - Medical Specialty Society
American Heart Association - Professional Association
Society for Cardiovascular Angiography and Interventions - Medical Specialty Society

The American College of Cardiology Foundation and the American Heart Association. No outside funding is accepted.

2005 Guideline

ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention

American College of Cardiology/American Heart Association Task Force on Practice Guidelines

2007 Focused Update

2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee

2005 Guideline

Writing Committee Members: Sidney C. Smith, Jr, MD, FACC, FAHA, Chair; Ted E. Feldman, MD, FACC, FSCAI*; John W. Hirshfeld, Jr, MD, FACC, FSCAI*; Alice K. Jacobs, MD, FACC, FAHA, FSCAI; Morton J. Kern, MD, FACC, FAHA, FSCAI*; Spencer B. King, III, MD, MACC, FSCAI; Douglass A. Morrison, MD, PhD, FACC, FSCAI*; William W. O'Neill, MD, FACC, FSCAI; Hartzell V. Schaff, MD, FACC, FAHA; Patrick L. Whitlow, MD, FACC, FAHA; David O. Williams, MD, FACC, FAHA, FSCAI

Task Force Members: Elliott M. Antman, MD, FACC, FAHA, Chair; Sidney C. Smith, Jr., MD, FACC, FAHA, Vice Chair; Cynthia D. Adams, MSN, APRN-BC, FAHA; Jeffrey L. Anderson, MD, FACC, FAHA; David P. Faxon, MD, FACC, FAHA**; Valentin Fuster, MD, PhD, FACC, FAHA, FESC**; Jonathan L. Halperin, MD, FACC, FAHA; Loren F. Hiratzka, MD, FACC, FAHA**; Sharon Ann Hunt, MD, FACC, FAHA; Alice K. Jacobs, MD, FACC, FAHA; Rick Nishimura, MD, FACC, FAHA; Joseph P. Ornato, MD, FACC, FAHA; Richard L. Page, MD, FACC, FAHA; Barbara Riegel, DNSc, RN, FAHA

*Society for Cardiovascular Angiography and Interventions (SCAI) Official Representative

**Former Task Force Member during this writing effort

2007 Focused Update

Writing Group Members: Spencer B. King III, MD, MACC, FAHA, FSCAI, Co-Chair; Sidney C. Smith, JR, MD, FACC, FAHA, Co-Chair; John W. Hirshfeld, JR, MD, FACC, FAHA, FSCAI*; Alice K. Jacobs, MD, FACC, FAHA, FSCAI; Douglass A. Morrison, MD, PHD, FACC, FSCAI*; David O. Williams, MD, FACC, FAHA, FSCAI

Task Force Members: Sidney C. Smith, JR, MD, FACC, FAHA, Chair; Alice K. Jacobs, MD, FACC, FAHA, Vice-Chair; Cynthia D. Adams, MSN, PHD, FAHA**; Jeffrey L. Anderson, MD, FACC, FAHA**; Christopher E. Buller, MD, FACC; Mark A. Creager, MD, FACC, FAHA; Steven M. Ettinger, MD, FACC; Jonathan L. Halperin, MD, FACC, FAHA**; Sharon A. Hunt, MD, FACC, FAHA**; Harlan M. Krumholz, MD, FACC, FAHA; Frederick G. Kushner, MD, FACC, FAHA; Bruce W. Lytle, MD, FACC, FAHA; Rick Nishimura, MD, FACC, FAHA; Richard L. Page, MD, FACC, FAHA; Barbara Riegel, DNSC, RN, FAHA**; Lynn G. Tarkington, RN; Clyde W. Yancy, MD, FACC

*Society for Cardiovascular Angiography and Interventions Representative

**Former Task Force member during this writing effort

2005 Guideline

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines makes every effort to avoid any actual, potential, or perceived conflicts of interest that might arise as a result of an outside relationship or personal interest of a member of the writing panel. Specifically, all members of the writing panel are asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest. These statements are reviewed by the parent task force, reported orally to all members of the writing panel at the first meeting, and updated and reviewed by the writing committee as changes occur.

Table: ACC/AHA/SCAI Committee to Update 2002 Guidelines for Percutaneous Coronary Intervention--Relationships with Industry

Note: This table represents the relevant relationships of authors with industry that were reported orally at the initial writing committee meeting in July 2002 and updated in conjunction with all meetings and conference calls of the writing committee. It does not reflect any actual or potential relationships at the time of publication.

See Appendix 2 in the original 2005 guideline document for information about relationships with industry of the external peer reviewers of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention.

2007 Focused Update

Table. Author Relationships with Industry—Writing Group to Develop the 2007 Percutaneous Coronary Intervention Focused Update of the ACC/AHA/SCAI 2005 Guidelines for Percutaneous Coronary Intervention

Note: This table represents the actual or potential relationships with industry that were reported as of September 24, 2007. This table was updated in conjunction with all conference calls of this writing committee. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% or more of the voting stock or share of the business entity, or ownership of $10,000 or more of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person's gross income for the previous year. A relationship is considered to be modest if it is less than significant under the preceding definition. Relationships in this table are modest unless otherwise noted.

*Recused from voting on Section 7: Antiplatelet Therapy.
**Significant (greater than $10,000) relationship
#Recused from voting on Section 8: Bare-Metal and Drug-Eluting Stents.

See Appendix 2 in the 2007 focused update document for information about relationships with industry of the external peer reviewers of the 2007 percutaneous coronary intervention focused update of the ACC/AHA/SCAI 2005 guidelines for percutaneous coronary intervention.

This is the current release of the guideline.

This guideline updates a previous version: Smith SC, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines). J Am Coll Cardiol 2001 Jun;37(8):2239i-lxvi.

None available

This summary was completed by ECRI on October 17, 2001. The information was verified by the guideline developer on January 18, 2002. This summary was updated by ECRI on January 13, 2006. The updated information was verified by the guideline developer on March 22, 2006. This summary was updated by ECRI on March 6, 2007 following the U.S. Food and Drug Administration (FDA) advisory on Coumadin (warfarin sodium). This summary was updated by ECRI Institute on June 22, 2007 following the U.S. Food and Drug Administration (FDA) advisory on heparin sodium injection. This summary was updated by ECRI Institute on July 12, 2007 following the U.S. Food and Drug Administration (FDA) advisory on Troponin-1 Immunoassay. This summary was updated by ECRI Institute on September 7, 2007 following the revised U.S. Food and Drug Administration (FDA) advisory on Coumadin (warfarin). This summary was updated by ECRI Institute on November 9, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs. This NGC summary was updated by ECRI Institute on March 25, 2008. The updated information was verified by the guideline developer on August 4, 2008.