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• W1993051841 abstract "HomeCirculationVol. 117, No. 22007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUB2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary InterventionA Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 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 Spencer B. KingIII, Sidney C. SmithJr, John W. HirshfeldJr, Alice K. Jacobs, Douglass A. Morrison, David O. Williams, 2005 WRITING COMMITTEE MEMBERS Sidney C. SmithJr, Ted E. Feldman, John W. HirshfeldJr, Alice K. Jacobs, Morton J. Kern, Spencer B. KingIII, Douglass A. Morrison, William W. O’Neill, Hartzell V. Schaff, Patrick L. Whitlow, David O. Williams, Sidney C. SmithJr, Alice K. Jacobs, Cynthia D. Adams, Jeffrey L. Anderson, Christopher E. Buller, Mark A. Creager, Steven M. Ettinger, Jonathan L. Halperin, Sharon A. Hunt, Harlan M. Krumholz, Frederick G. Kushner, Bruce W. Lytle, Rick Nishimura, Richard L. Page, Barbara Riegel, Lynn G. Tarkington and Clyde W. Yancy Spencer B. KingIIISpencer B. KingIII Search for more papers by this author , Sidney C. SmithJrSidney C. SmithJr Search for more papers by this author , John W. HirshfeldJrJohn W. HirshfeldJr Search for more papers by this author , Alice K. JacobsAlice K. Jacobs Search for more papers by this author , Douglass A. MorrisonDouglass A. Morrison Search for more papers by this author , David O. WilliamsDavid O. Williams Search for more papers by this author , 2005 WRITING COMMITTEE MEMBERS Search for more papers by this author , Sidney C. SmithJrSidney C. SmithJr Search for more papers by this author , Ted E. FeldmanTed E. Feldman Search for more papers by this author , John W. HirshfeldJrJohn W. HirshfeldJr Search for more papers by this author , Alice K. JacobsAlice K. Jacobs Search for more papers by this author , Morton J. KernMorton J. Kern Search for more papers by this author , Spencer B. KingIIISpencer B. KingIII Search for more papers by this author , Douglass A. MorrisonDouglass A. Morrison Search for more papers by this author , William W. O’NeillWilliam W. O’Neill Search for more papers by this author , Hartzell V. SchaffHartzell V. Schaff Search for more papers by this author , Patrick L. WhitlowPatrick L. Whitlow Search for more papers by this author , David O. WilliamsDavid O. Williams Search for more papers by this author , Sidney C. SmithJrSidney C. SmithJr Search for more papers by this author , Alice K. JacobsAlice K. Jacobs Search for more papers by this author , Cynthia D. AdamsCynthia D. Adams Search for more papers by this author , Jeffrey L. AndersonJeffrey L. Anderson Search for more papers by this author , Christopher E. BullerChristopher E. Buller Search for more papers by this author , Mark A. CreagerMark A. Creager Search for more papers by this author , Steven M. EttingerSteven M. Ettinger Search for more papers by this author , Jonathan L. HalperinJonathan L. Halperin Search for more papers by this author , Sharon A. HuntSharon A. Hunt Search for more papers by this author , Harlan M. KrumholzHarlan M. Krumholz Search for more papers by this author , Frederick G. KushnerFrederick G. Kushner Search for more papers by this author , Bruce W. LytleBruce W. Lytle Search for more papers by this author , Rick NishimuraRick Nishimura Search for more papers by this author , Richard L. PageRichard L. Page Search for more papers by this author , Barbara RiegelBarbara Riegel Search for more papers by this author , Lynn G. TarkingtonLynn G. Tarkington Search for more papers by this author and Clyde W. YancyClyde W. Yancy Search for more papers by this author Originally published13 Dec 2007https://doi.org/10.1161/CIRCULATIONAHA.107.188208Circulation. 2008;117:261–295is corrected byCorrectionOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: December 13, 2007: Previous Version 1 Preamble…2621. Introduction…264 1.1. Evidence Review…264 1.2. Organization of Committee and Relationships With Industry…264 1.3. Review and Approval…2642. 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…2723. Facilitated PCI…2734. Rescue PCI…2755. PCI After Fibrinolysis or for Patients Not Undergoing Primary Reperfusion…2776. Ancillary Therapy for Patients Undergoing PCI for STEMI…2787. Antiplatelet Therapy…2788. Bare-Metal and Drug-Eluting Stents…281 8.1. Selection of a Bare-Metal or Drug-Eluting Stent…2819. Secondary Prevention…283References…288Appendix 1…293Appendix 2…293PreambleA 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 data deemed to have an impact on patient care (see Section 1.1 for details regarding this focused update). 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 journalLarge, randomized, placebo-controlled trial(s)Nonrandomized data deemed important on the basis of results that impact current safety and efficacy assumptionsStrengths/weakness of research methodology and findingsLikelihood of additional studies influencing current findingsImpact 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 biasNumber of previous trials showing consistent resultsNeed for consistency with other new guidelines or guideline revisionsIn analyzing the data and developing updated recommendations and supporting text, the focused update writing group used evidence-based methodologies developed by the ACC/AHA Task Force on Practice Guidelines, which are described elsewhere.1,2The schema for class of recommendation and level of evidence is summarized in Table 1, 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. Download figureDownload PowerPointTable 1. 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.†In 2003, the 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.The 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.The ACC/AHA Task Force on Practice Guidelines makes every effort to avoid any actual, potential, or perceived conflict of interest arising from industry relationships or personal interests of a writing committee member. All writing committee members and peer reviewers were required to provide disclosure statements of all such relationships pertaining to the trials and other evidence under consideration (see Appendixes 1 and 2). Final recommendations were balloted to all writing committee members. Writing committee members with significant (greater than $10 000) relevant relationships with industry (RWI) were required to recuse themselves from voting on that recommendation. Writing committee members who did not participate are not listed as authors of this focused update.With the exception of the recommendations presented in this statement, the full guidelines remain current. Only the recommendations from the affected section(s) of the full guidelines are included in this focused update. For easy reference, all recommendations from any section of guidelines impacted by a change are presented with a notation as to whether they remain current, are new, or have been modified. When evidence impacts recommendations in more than 1 set of guidelines, those guidelines are updated concurrently.The recommendations in this focused update will be considered current until they are superseded by another focused update or the full-text guidelines are revised. This focused update is published in the January 15, 2008, issue of the Journal of the American College of Cardiology, the January 15, 2008, issue of Circulation, and e-published in Catheterization and Cardiovascular Interventions as an update to the full-text guidelines and is posted on the ACC (www.acc.org), AHA (my.americanheart.org), and Society for Angiography and Interventions (SCAI) (www.scai.org) Web sites. Copies of the focused update are available from all organizations.Sidney C. Smith, Jr., MD, FACC, FAHAChair, ACC/AHA Task Force on Practice GuidelinesAlice K. Jacobs, MD, FACC, FAHAVice-Chair, ACC/AHA Task Force on Practice Guidelines1. Introduction1.1. Evidence ReviewSelected late-breaking clinical trials presented at the 2005 and 2006 annual scientific meetings of the ACC, 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/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention.3–13To 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.Consult the full-text version or executive summary of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention for policy on clinical areas not covered by the focused update.13a Individual recommendations updated in this focused update will be incorporated into future revisions and/or updates of the full-text guidelines.1.2. Organization of Committee and Relationships With IndustryFor this focused update, all members of the 2005 PCI writing committee were invited to participate; those who agreed (referred to as the 2007 focused update writing group) were required to disclose all RWI relevant to the data under consideration.2 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.1.3. Review and ApprovalThis document was reviewed by 2 outside reviewers nominated by each cosponsoring organization (ACC, AHA, and SCAI) and 24 individual content reviewers. All reviewer RWI information was collected and distributed to the writing committee and is published in this document (see Appendix 2 for details).This document was approved for publication by the governing bodies of the American College of Cardiology Foundation, AHA, and SCAI.2. Patients With Unstable Angina/Non–ST-Elevation Myocardial InfarctionThis 2007 PCI Focused Update section regarding patients with unstable angina (UA)/non–ST-elevation myocardial infarction (NSTEMI) is based on recommendations from the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction,14 which emphasize the importance of assessing risk of cardiovascular events as a guide to therapeutic decision making and the need for interventional therapy (see Table 2). Table 2. Updates to Section 5.3: Initial Conservative Versus Initial Invasive Strategies (Patients With UA/NSTEMI)2005 PCI Guideline Update Recommendation2007 PCI Focused Update RecommendationCommentsClass IAn early invasive PCI strategy is indicated for patients with UA/NSTEMI who have no serious comorbidity† and coronary lesions amenable to PCI. Patients must have any of the following high-risk features:1. An early invasive PCI strategy is indicated for patients with UA/NSTEMI who have no serious comorbidity† and who have coronary lesions amenable to PCI and who have characteristics for invasive therapy (see Table 3 and Section 3.3 of the ACC/AHA 2007 UA/NSTEMI Guidelines).14(Level of Evidence: A)Modified recommendation*a. Recurrent ischemia despite intensive anti-ischemic therapy. (Level of Evidence: A)b. Elevated troponin level. (Level of Evidence: A)c. New ST-segment depression. (Level of Evidence: A)d. HF symptoms or new or worsening MR. (Level of Evidence: A)e. Depressed LV systolic function. (Level of Evidence: A)f. Hemodynamic instability. (Level of Evidence: A)g. Sustained ventricular tachycardia. (Level of Evidence: A)h. PCI within 6 months. (Level of Evidence: A)i. Prior CABG. (Level of Evidence: A) j. High risk score (e.g., TIMI, GRACE). (Level of Evidence: A)k. High risk findings from non-invasive testing. (Level of Evidence: A)2. Percutaneous coronary intervention (or CABG) is recommended for UA/NSTEMI patients with 1- or 2-vessel CAD with or without significant proximal left anterior descending CAD but with a large area of viable myocardium and high-risk criteria on noninvasive testing. (Level of Evidence: B)New recommendation*3. Percutaneous coronary intervention (or CABG) is recommended for UA/NSTEMI patients with multivessel coronary disease with suitable coronary anatomy, with normal LV function, and without diabetes mellitus. (Level of Evidence: A)New recommendation*4. An intravenous platelet GP IIb/IIIa inhibitor is useful in UA/NSTEMI patients undergoing PCI. (Level of Evidence: A) See Section 3.2.3 and Table 13 of the 2007 ACC/AHA 2007 UA/NSTEMI Guidelines.14New recommendation*5. An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is indicated in UA/NSTEMI patients who have refractory angina or hemodynamic or electrical instability (without serious comorbidities or contraindications to such procedures). (Level of Evidence: B)New recommendation*Table 2. Continued2005 PCI Guideline Update Recommendation2007 PCI Focused Update RecommendationCommentsClass IIaIt is reasonable that PCI be performed in patients with UA/NSTEMI and single-vessel or multivessel CAD who are undergoing medical therapy with focal saphenous vein graft lesions or multiple stenoses who are poor candidates for reoperative surgery. (Level of Evidence: C)1. Percutaneous coronary intervention is reasonable for focal saphenous vein graft lesions or multiple stenoses in UA/NSTEMI patients who are undergoing medical therapy and who are poor candidates for reoperative surgery. (Level of Evidence: C)Modified recommendation*In the absence of high-risk features associated with UA/NSTEMI, it is reasonable to perform PCI in patients with amenable lesions and no contraindication for PCI with either an early invasive or early conservative strategy. (Level of Evidence: B)Deleted recommendation*2. Percutaneous coronary intervention (or CABG) is reasonable for UA/NSTEMI patients with 1- or 2-vessel CAD with or without significant proximal left anterior descending CAD but with a moderate area of viable myocardium and ischemia on noninvasive testing. (Level of Evidence: B)New recommendation*3. Percutaneous coronary intervention (or CABG) can be beneficial compared with medical therapy for UA/NSTEMI patients with 1-vessel disease with significant proximal left anterior descending CAD. (Level of Evidence: B)New recommendation*Use of PCI is reasonable in patients with UA/NSTEMI with significant left main CAD (greater than 50% diameter stenosis) who are candidates for revascularization but are not eligible for CABG. (Level of Evidence: B)4. Use of PCI is reasonable in patients with UA/NSTEMI with significant left main CAD (greater than 50% diameter stenosis) who are candidates for revascularization but are not eligible for CABG or who require emergency intervention at angiography for hemodynamic instability. (Level of Evidence: B)2005 recommendation remains current in 2007 PCI Update but receives additional wording.Class IIbIn the absence of high-risk features associated with UA/NSTEMI, PCI may be considered in patients with single-vessel or multivessel CAD who are undergoing medical therapy and who have 1 or more lesions to be dilated with a less than optimal likelihood of success. (Level of Evidence: B)1. In the absence of high-risk features associated with UA/NSTEMI, PCI may be considered in patients with single-vessel or multivessel CAD who are undergoing medical therapy and who have 1 or more lesions to be dilated with a reduced likelihood of success. (Level of Evidence: B)Modified recommendation*PCI may be considered in patients with UA/NSTEMI who are undergoing medical therapy who have 2- or 3-vessel disease, significant proximal LAD CAD, and treated diabetes or abnormal LV function. (Level of Evidence: B)2. PCI may be considered in patients with UA/NSTEMI who are undergoing medical therapy who have 2- or 3-vessel disease, significant proximal left anterior descending CAD, and treated diabetes or abnormal LV function, with anatomy suitable for catheter-based therapy. (Level of Evidence: B)2005 recommendation remains current in 2007 PCI Update but receives additional wording.3. In initially stabilized patients, an initially conservative (i.e., a selectively invasive) strategy may be considered as a treatment strategy for UA/NSTEMI patients (without serious comorbidities or contraindications to such procedures†) who have an elevated risk for clinical events (see Table 3) including those who are troponin positive. (Level of Evidence: B). The decision to implement an initial conservative (versus initial invasive) strategy‡ in these patients may be made by considering physician and patient preference. (Level of Evidence: C)New recommendation*4. An invasive strategy may be reasonable in patients with chronic renal insufficiency. (Level of Evidence: C)New recommendation*Class III1. Percutaneous coronary intervention (or CABG) is not recommended for patients with 1- or 2-vessel CAD without significant proximal left anterior descending CAD with no current symptoms or symptoms that are unlikely to be due to myocardial ischemia and who have no ischemia on noninvasive testing. (Level of Evidence: C)New recommendation*Table 2. Continued2005 PCI Guideline Update Recommendation2007 PCI Focused Update RecommendationComments*Based on the ACC/AHA 2007 UA/NSTEMI Guidelines.14†For example, severe hepatic, pulmonary, or renal failure, or active/inoperable cancer. Clinical judgment is required in such cases.‡Diagnostic angiography with intent to perform revascularization.CABG indicates coronary artery bypass graft; CAD, coronary artery disease; GP, glycoprotein; GRACE, Global Registry of Acute Coronary Events; HF, heart failure; IV, intravenous; LAD, left anterior descending; LV, left ventricular; MR, mitral regurgitation; PCI, percutaneous coronary intervention; SVG, saphenous vein graft; TIMI, Thrombolysis in Myocardial Infarction; and UA/NSTEMI, unstable angina/non–ST-elevation myocardial infarction.In the absence of high-risk features associated with UA/NSTEMI, PCI is not recommended for patients with UA/NSTEMI who have single-vessel or multivessel CAD and no trial of medical therapy, or who have 1 or more of the following:2. In the absence of high-risk features associated with UA/NSTEMI, PCI is not recommended for patients with UA/NSTEMI who have single-vessel or multivessel CAD and no trial of medical therapy, or who have 1 or more of the following:2005 recommendation remains current in 2007 PCI Update a. Only a small area of myocardium at risk. (Level of Evidence: C) a. Only a small area of myocardium at risk. (Level of Evidence: C) b. All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. (Level of Evidence: C) b. All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. (Level of Evidence: C) c. A high risk of procedure-related morbidity or mortality. (Level of Evidence: C) d. Insignificant disease (less than 50% coronary stenosis). (Level of Evidence: C) c. A high risk of procedure-related morbidity or mortality. (Level of Evidence: C) e. Significant left main CAD and candidacy for CABG. (Level of Evidence: B) d. Insignificant disease (less than 50% coronary stenosis). (Level of Evidence: C) e. Significant left main CAD and candidacy for CABG. (Level of Evidence: B)3. A PCI strategy in stable patients (see Table 12 Class III No. 1 for specific recommendations) with persistently occluded infarct related coronary arteries after STEMI/NSTEMI is not indicated. (Level of Evidence: B)New recommendation*Because of the importance of several new changes in the ACC/AHA 2007 UA/NSTEMI Guidelines, selected text from the guidelines is included in the following paragraphs and summarized in Table 2.A number of risk-assessment tools have been developed to assist in assessing risk of death and ischemic events in patients with UA/NSTEMI, thereby providing a basis for therapeutic decision making. It should be recognized that the predictive ability of these commonly used risk assessment scores for risk of nonfatal coronary heart disease (CHD) is only moderate.The Thrombolysis in Myocardial Infarction (TIMI) risk score15 is a simple tool composed of 7 (1-point) risk indicators rated on presentation (Table 4). The composite end points (all-cause mortality, new or recurrent myocardial infarction [MI], or severe recurrent ischemia prompting urgent revascularization within 14 days) increase as the TIMI risk score increases. The TIMI risk score has been validated internally within the TIMI IIB trial and 2 separate cohorts of patients from the ESSENCE (Efficacy and Safety of Subcutaneous Enoxaparin in Unstable Angina and Non–Q-Wave Myocardial Infarction) trial.16 The model remained a significant predictor of events and appeared relatively insensitive to missing information, such as knowledge of previously documented coronary stenosis of 50% or greater. The model’s predictive ability remained intact, with a cutoff of 65 years of age. The TIMI risk score was recently studied in an unselected emergency department population with chest pain syndrome; its performance was similar to that in the acute coronary syndrome (ACS) population from which it was derived and validated.17 The TIMI risk calculator is available at www.timi.org. The TIMI risk index, a modification of the TIMI risk score that uses the variables age, systolic blood pressure, and heart rate, has not only been shown to predict short-term mortality in ST-elevation myocardial infarction (STEMI) but also has been useful in prediction of 30-day and 1-year mortality rates across the spectrum of patients with ACS, including UA/NSTEMI.18Table 4. TIMI Risk Score for Unstable Angina/Non–ST-Elevation Myocardial InfarctionTIMI Risk ScoreAll-Cause Mortality, New or Recurrent MI, or Severe Recurrent Ischemia Requiring Urgent Revascularization Through 14 Days After Randomization, %The TIMI risk score is determined by the sum of the presence of 7 variables at admission; 1 point is given for each of the following variables: age 65 years or older; at least 3 risk factors for CAD; prior coronary stenosis of 50% or more; ST-segment deviation on ECG presentation; at least 2 anginal events in prior 24 hours; use of aspirin in prior 7 days; and elevated serum cardiac biomarkers. Prior coronary stenosis of 50% or more remained relatively insensitive to missing information and remained a significant predictor of events. Reprinted with permission from Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835–42.15 Copyright © 2000 American Medical Association.CAD indicates coronary artery disease; ECG, electrocardiogram; MI, myocardial infarction; and TIMI, Thrombolysis in Myocardial Infarction.0–14.728.3313.2419.9526.26–740.9The PURSUIT (Platelet Glycoprotein IIb-IIIa in Unstable Angina: Receptor Suppression Using Integrilin Thera" @default.
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• W1993051841 title "2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention" @default.
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