ACC/AHA/SCAI PRACTICE GUIDELINE
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention—Summary Article
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
Sidney C. Smith, Jr, MD, FACC, FAHA, Chair, WRITING COMMITTEE MEMBERS,
Ted E. Feldman, MD, FACC, FSCAI, WRITING COMMITTEE MEMBERS*,
John W. Hirshfeld, Jr, MD, FACC, FSCAI, WRITING COMMITTEE MEMBERS*,
Alice K. Jacobs, MD, FACC, FAHA, FSCAI, WRITING COMMITTEE MEMBERS,
Morton J. Kern, MD, FACC, FAHA, FSCAI, WRITING COMMITTEE MEMBERS*,
Spencer B. King, III, MD, MACC, FSCAI, WRITING COMMITTEE MEMBERS,
Douglass A. Morrison, MD, PhD, FACC, FSCAI, WRITING COMMITTEE MEMBERS*,
William W. O’Neill, MD, FACC, FSCAI, WRITING COMMITTEE MEMBERS,
Hartzell V. Schaff, MD, FACC, FAHA, WRITING COMMITTEE MEMBERS,
Patrick L. Whitlow, MD, FACC, FAHA, WRITING COMMITTEE MEMBERS,
David O. Williams, MD, FACC, FAHA, FSCAI, WRITING COMMITTEE MEMBERS,
Elliott M. Antman, MD, FACC, FAHA, Chair, TASK FORCE MEMBERS,
Sidney C. Smith, Jr, MD, FACC, FAHA, Vice-Chair, TASK FORCE MEMBERS,
Cynthia D. Adams, MSN, APRN-BC, FAHA, TASK FORCE MEMBERS,
Jeffrey L. Anderson, MD, FACC, FAHA, TASK FORCE MEMBERS,
David P. Faxon, MD, FACC, FAHA, TASK FORCE MEMBERS ,
Valentin Fuster, MD, PhD, FACC, FAHA, FESC, TASK FORCE MEMBERS,
Jonathan L. Halperin, MD, FACC, FAHA, TASK FORCE MEMBERS,
Loren F. Hiratzka, MD, FACC, FAHA, TASK FORCE MEMBERS,
Sharon Ann Hunt, MD, FACC, FAHA, TASK FORCE MEMBERS,
Alice K. Jacobs, MD, FACC, FAHA, TASK FORCE MEMBERS,
Rick Nishimura, MD, FACC, FAHA, TASK FORCE MEMBERS,
Joseph P. Ornato, MD, FACC, FAHA, TASK FORCE MEMBERS,
Richard L. Page, MD, FACC, FAHA, TASK FORCE MEMBERS and
Barbara Riegel, DNSc, RN, FAHA, TASK FORCE MEMBERS
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Abbreviations and Acronyms
| | CABG = coronary artery bypass graft surgery | | CAD = coronary artery disease | | CK = creatine kinase | | DES = drug-eluting stent | | ECG = electrocardiogram | | GP = glycoprotein | | HF = heart failure | | IVUS = intravascular ultrasound | | LAD = left anterior descending artery | | LBBB = left bundle-branch block | | LV = left ventricular | | MB = cardiac muscle isoenzyme of creatine kinase | | MI = myocardial infarction | | MR = mitral regurgitation | | NSTEMI = non–ST-elevation myocardial infarction | | PCI = percutaneous coronary intervention | | STEMI = ST-elevation myocardial infarction | | UA = unstable angina |
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The American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) 2005 Guideline Update for Percutaneous Coronary Intervention (PCI) contains changes in the recommendations, along with supporting text. For the purpose of comparison, this summary contains a list of the updated recommendations (middle column) alongside a list of the 2001 recommendations (left column), with each set accompanied by a comment (right column) that provides the rationale for the changes, additions, or deletions (see Table 1). References that support either the 2001 recommendations that have changed or the new or revised recommendations are cited in parentheses at the end of each recommendation or comment. A list of abbreviations is included in the Appendix. The reader is referred to the full-text guideline posted on the World Wide Web sites of the ACC, the AHA, and the SCAI for a more detailed explanation of the changes discussed here. Please note that we have changed the table of contents headings in the 2001 ACC/AHA Guidelines for Percutaneous Coronary Intervention from roman numerals to unique identifying numbers.
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2001 Table. Recommendations for Pharmacological Management of Patients Undergoing PCI—For Comparison Purposes Only (Deleted From 2005 Guideline)
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In preparing this update, the committee was guided by the following principles:
- 1 Changes in recommendations and levels of evidence were made because of the availability of data from new randomized trials, the accumulation of new clinical evidence, and/or the development of clinical consensus.
- 2 The committee is cognizant of the healthcare, logistic, and financial implications of recent trials and factored in these considerations in arriving at the class level of certain recommendations.
- 3 All recommendations in the PCI guideline update 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, will still convey the full intent of the recommendation.
- 4 The committee wishes to re-emphasize that the recommendations in the guideline apply to most patients but may require modification by existing situations that only the primary treating healthcare provider can evaluate properly.
- 5 The committee endeavored to maintain the consistency of recommendations in this and other previously published guidelines, primarily the ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction and the ACC/AHA 2002 Guideline Update for the Management of Patients With Non–ST-Elevation Myocardial Infarction.
The classification of recommendations and levels of evidence are expressed in the ACC/AHA format as follows:
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Classification of Recommendations
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- 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.
- IIa: Weight of evidence/opinion is in favor of usefulness/efficacy.
- 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.
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Level of Evidence
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- Level of Evidence A: Data derived from multiple randomized clinical trials or meta-analyses.
- Level of Evidence B: Data derived from a single randomized trial or nonrandomized studies.
- Level of Evidence C: Only consensus opinion of experts, case studies, or standard-of-care.
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Acknowledgments
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The ACC and AHA recognize Dr J. Ward Kennedy for his dedicated service on developing ACC/AHA guidelines for PTCA and PCI since their inception in 1986 and for his counsel and advice in the preparation of this guideline.
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Footnotes
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This document was approved by the American College of Cardiology Foundation Board of Trustees in September 2005, by the American Heart Association Science Advisory and Coordinating Committee in September 2005, and by the Society for Cardiovascular Angiography and Interventions in September 2005.
The ACC/AHA Task Force on Practice Guidelines makes every effort to avoid any actual or potential 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 as changes occur. The relationship with industry information for writing committee members, as well as peer reviewers of the document, is located in an appendix of the full-text guideline, which is available on the ACC, AHA, and SCAI Web sites.
When citing this document, the American Heart Association requests that the following citation format be used: Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB III, Morrison DA, O’Neill WW, Schaff HV, Whitlow PL, Williams DO. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006;47:216–35.
Copies: This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (www.americanheart.org), and the Society for Cardiovascular Angiography and Interventions (www.scai.org). Single copies of this document are available by calling 1-800-253-4636 or writing the American College of Cardiology Foundation, Resource Center, at 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Ask for reprint number 71-0346. To obtain a copy of the full text published in the January 3, 2006, issue of the Journal of the American College of Cardiology, the January 3, 2006, issue of Circulation, and the January 2006, issue of Catheterization and Cardiovascular Interventions, ask for reprint number 71-0347. To purchase bulk reprints (specify version and reprint number): Up to 999 copies, call 1-800-611-6083 US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1789, fax 214-691-6342, or e-mail mailto:pubauth{at}heart.org.
Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please direct requests to mailto:copyright_permissions{at}acc.org.
* Official SCAI representative. 
 Former Task Force Member during this writing effort.
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