Avoid PCI in stable, asymptomatic patients with normal or only mildly abnormal adequate stress test results.
For patients with stable ischemic heart disease, in the absence of symptoms, there is limited clinical benefit to PCI unless performed on a lesion with demonstrable hemodynamic significance (FFR <0.8) or causing a significant amount of ischemia as assessed by non-invasive stress testing. Rare exceptions would be a significant left main coronary artery lesion or a >90% proximal lesion in a major coronary artery.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
Members of the SCAI Quality Improvement Committee reviewed the appropriate use criteria for catheterization and percutaneous coronary revascularization, and the guidelines for stable ischemic heart disease and percutaneous coronary revascularization. The Committee extracted this list from these documents, which have been developed by the Society for Cardiovascular Angiography and Interventions, American College of Cardiology Foundation, American Heart Association and other professional societies over the past four years.
Appropriate use criteria grade clinical scenarios as appropriate, uncertain (or sometimes appropriate), or inappropriate (or rarely appropriate) for catheterization or coronary intervention. Guidelines describe circumstances when catheterization or coronary interventions are recommended (Class I), are probably recommended (Class IIa), may be reasonable (Class IIb), or are not recommended (Class III). The items in thisChoosing Wisely® list were selected from among the scenarios rated as inappropriate (or rarely appropriate) by the appropriate use criteria or as Class III (not recommended) by the guidelines. These items were selected (rather than making new items forChoosing Wisely®) because these appropriate use criteria and guidelines have been carefully vetted, adjudicated and agreed upon by myriad experts from many societies.
The proposed Choosing Wisely® items were critiqued by the SCAI Quality Improvement Committee and several authors of documents cited in this list. They were approved by the SCAI Executive Committee. The Committees would like to emphasize that the science of guidelines and appropriate use criteria should be complementary to the art of clinical judgment for best care of the individual patient.
SCAI’s disclosure and conflict of interest policy can be found at www.scai.org.
Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2012 Feb 28;59(9):857–81.
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44–122.