Brief Summary

GUIDELINE TITLE

BIBLIOGRAPHIC SOURCE(S)

• Finnish Medical Society Duodecim. Coronary angiography and indications for CABG or angioplasty. In: EBM Guidelines. Evidence-Based Medicine [CD-ROM]. Helsinki, Finland: Duodecim Medical Publications Ltd.; 2004 Sep 14 [Various].

GUIDELINE STATUS

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

• To determine the extent of anatomic coronary artery obstruction when coronary artery bypass grafting (CABG) (Yusuf et al., 1994; DARE-920031, 1999; Rihal, 2002; Davies et al., 1997) [A] or percutaneous transluminal coronary angioplasty (PTCA) (Sim et al., 1995; DARE-953385, 1999) [A] is considered.
• To evaluate difficult diagnostic problems in patients with unstable angina, survival of sudden death, atypical chest pain.

• Severe stable AP resistant to medication
• Occlusion of left anterior descending artery (LAD) or a 3-vessel disease is suspected on the basis of an exercise tolerance test(also when the symptoms are mild)
• Ischaemic ST (>2 mm) with minimal load and low heart rate
• Deficient rise in blood pressure (BP) during exercise test
• AP after acute myocardial infarction
• Pain at rest or when walking while the patient is still in the hospital
• AP and severe heart failure (myocardial stunning)
• ST-depression outside the infarction area during exercise
• Unstable AP resistant to medication
• AP following PTCA
• In cases of rapidly recurring AP after coronary artery bypass grafting, PTCA may be considered.

• Angiography may be indicated or considered:
• In patients accepted for heart surgery (e.g., valve prosthesis)
• In survivors of ventricular fibrillation without myocardial infarction (MI)
• When the exercise electrocardiogram (ECG) changes are clearly pathological
• In acute pulmonary oedema without cause
• When electrocardiogram after a T-wave infarction (non-Q-wave infarction) shows long lasting and wide T inversions in anterior wall leads
• As a diagnostic method in special situations (e.g., left bundle branch block [LBBB] and left ventricular hypertrophy [LVH] disturb the interpretation of the exercise test)

• Acute PTCA is preferred to thrombolysis whenever available (Grines et al., 2003; DARE-20030287, 2004; Keeley, Boura, & Grines, 2003; DARE-20038039, 2004) [A]: the results are better and the price is lower
• Acute PTCA may be an alternative to thrombolysis also when the latter is contraindicated or shows no effect

• Patients with moderate to severe left ventricular systolic dysfunction and concomitant limiting angina have improved survival and physical functioning after coronary artery bypass grafting (Baker et al., 1994; DARE-944148, 1999) [C].
• The medium and long-term outcomes after balloon angioplasty are favourable with a low mortality and myocardial infarction rate and a low rate of later restenosis (after 6 months) (de Feyter et al., 1994; DARE-940217, 1999) [C].
• PTCA may lead to greater reduction in angina, but there is no evidence of improved survival or reduction in the subsequent need for revascularization, although trends do not favour angioplasty (Bucher et al., 2000; DARE-20008332, 2001) [C].
• In patients undergoing percutaneous revascularization, platelet glycoprotein IIb/IIIa receptor antagonists reduce death, myocardial infarction, and need for urgent reintervention (Bosch & Marrugat, 2004; Vorchheimer, Badimon, & Fuster, 1999; DARE-998484, 2000) [A].
• Ticlopidine plus aspirin is more effective than oral anticoagulation in preventing coronary events in patients undergoing coronary stenting (Cosmi et al., 2004) [A].

1. Strong research-based evidence. Multiple relevant, high-quality scientific studies with homogenic results.
2. Moderate research-based evidence. At least one relevant, high-quality study or multiple adequate studies.
3. Limited research-based evidence. At least one adequate scientific study.
4. No research-based evidence. Expert panel evaluation of other information.

CLINICAL ALGORITHM(S)

EVIDENCE SUPPORTING THE RECOMMENDATIONS

REFERENCES SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

• Finnish Medical Society Duodecim. Coronary angiography and indications for CABG or angioplasty. In: EBM Guidelines. Evidence-Based Medicine [CD-ROM]. Helsinki, Finland: Duodecim Medical Publications Ltd.; 2004 Sep 14 [Various].

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