Difference between revisions of "Myocardial revascularization"

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* [[Coronary atherectomy]] which is a "percutaneous transluminal procedure for removing atheromatous plaque from the [[coronary artery|coronary arteries]]. Both directional (for removing focal atheromas) and rotational (for removing concentric atheromatous plaque) atherectomy devices have been used."<ref>{{MeSH|Coronary Atherectomy}}</ref>
* [[Coronary atherectomy]] which is a "percutaneous transluminal procedure for removing atheromatous plaque from the [[coronary artery|coronary arteries]]. Both directional (for removing focal atheromas) and rotational (for removing concentric atheromatous plaque) atherectomy devices have been used."<ref>{{MeSH|Coronary Atherectomy}}</ref>


Coronary artery bypass is more effective  for myocardial revascularization of [[coronary heart disease]] than [[percutaneous transluminal coronary angioplasty]]<ref name="pmid-17938385">{{cite journal |author=Bravata DM, Gienger AL, McDonald KM, ''et al'' |title=Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Surgery |journal=Ann Intern Med |volume= |issue= |pages= |year=2007 |pmid=17938385 |doi=}}</ref>, especially for patients with diabetes who have stenosis of three [[coronary artery|coronary arteries]].<ref name="pmid8657237">{{cite journal |author= |title=Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators |journal=N. Engl. J. Med. |volume=335 |issue=4 |pages=217–25 |year=1996 |month=July |pmid=8657237 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8657237&promo=ONFLNS19 |issn=}}</ref> Coronary artery bypass is also more effective than [[percutaneous transluminal coronary angioplasty]] with drug-eluting stents; however, bypass may increase the rate of stroke.<ref name="pmid19228612">{{cite journal |author=Serruys PW, Morice MC, Kappetein AP, ''et al'' |title=Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease |journal=N. Engl. J. Med. |volume=360 |issue=10 |pages=961–72 |year=2009 |month=March |pmid=19228612 |doi=10.1056/NEJMoa0804626 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19228612&promo=ONFLNS19 |issn=}}</ref> The [http://www.syntaxscore.com/ SYNTAX score] may help determine choice of procedure for myocardial revascularization.<ref name="pmid17437730">{{cite journal |author=Valgimigli M, Serruys PW, Tsuchida K, ''et al'' |title=Cyphering the complexity of coronary artery disease using the syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention |journal=Am. J. Cardiol. |volume=99 |issue=8 |pages=1072–81 |year=2007 |month=April |pmid=17437730 |doi=10.1016/j.amjcard.2006.11.062 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)00072-0 |issn=}}</ref>
[[Clinical practice guideline]]s address management and selection of patients.<ref name="pmid22064601">{{cite journal| author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al.| title=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. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064601 | doi=10.1161/CIR.0b013e31823ba622 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064601  }} </ref>


Of patients without indications for myocardial revascularization, cardiologists will recommended [[percutaneous transluminal coronary angioplasty]]  for 21% of patients.<ref name="pmid20048207">{{cite journal|  author=Hannan EL, Racz MJ, Gold J, Cozzens K, Stamato NJ, Powell T et  al.| title=Adherence of catheterization laboratory cardiologists to  American College of Cardiology/American Heart Association guidelines for  percutaneous coronary interventions and coronary artery bypass graft  surgery: what happens in actual practice? | journal=Circulation | year=  2010 | volume= 121 | issue= 2 | pages= 267-75 | pmid=20048207 |  doi=10.1161/CIRCULATIONAHA.109.887539 | pmc= |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20048207  }} </ref> A second study found that 12% of [[percutaneous transluminal coronary angioplasty|percutaneous transluminal coronary angioplasties]] were done for inappropriate reasons.<ref name="pmid21730241">{{cite journal| author=Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K et al.| title=Appropriateness of percutaneous coronary intervention. | journal=JAMA | year= 2011 | volume= 306 | issue= 1 | pages= 53-61 | pmid=21730241 | doi=10.1001/jama.2011.916 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21730241  }} </ref>
Elective [[percutaneous transluminal coronary angioplasty]] is not clearly better to optimal medical therapy.<ref name="pmid17387127">{{cite journal| author=Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ et al.| title=Optimal medical therapy with or without PCI for stable coronary disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 15 | pages= 1503-16 | pmid=17387127 | doi=10.1056/NEJMoa070829 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17387127  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17608377 Review in: ACP J Club. 2007 Jul-Aug;147(1):12]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17612033 Review in: J Fam Pract. 2007 Jul;56(7):529]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17885155 Review in: Evid Based Med. 2007 Aug;12(4):107] </ref>
 
Coronary artery bypass is more effective for myocardial revascularization of [[coronary heart disease]] than [[percutaneous transluminal coronary angioplasty]]<ref name="pmid-17938385">{{cite journal |author=Bravata DM, Gienger AL, McDonald KM, ''et al'' |title=Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Surgery |journal=Ann Intern Med |volume= |issue= |pages= |year=2007 |pmid=17938385 |doi=}}</ref>, especially for patients with diabetes who have stenosis of two[[coronary artery|coronary arteries]].<ref name="pmid23121323">{{cite journal| author=Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M et al.| title=Strategies for Multivessel Revascularization in Patients with Diabetes. | journal=N Engl J Med | year= 2012 | volume=  | issue=  | pages=  | pmid=23121323 | doi=10.1056/NEJMoa1211585 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23121323  }} </ref><ref name="pmid23121323">{{cite journal| author=Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M et al.| title=Strategies for Multivessel Revascularization in Patients with Diabetes. | journal=N Engl J Med | year= 2012 | volume=  | issue=  | pages=  | pmid=23121323 | doi=10.1056/NEJMoa1211585 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23121323  }} </ref><ref name="pmid8657237">{{cite journal |author= |title=Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators |journal=N. Engl. J. Med. |volume=335 |issue=4 |pages=217–25 |year=1996 |month=July |pmid=8657237 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8657237&promo=ONFLNS19 |issn=}}</ref> Coronary artery bypass is also more effective than [[percutaneous transluminal coronary angioplasty]] with drug-eluting stents; however, bypass may increase the rate of stroke.<ref name="pmid23121323">{{cite journal| author=Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M et al.| title=Strategies for Multivessel Revascularization in Patients with Diabetes. | journal=N Engl J Med | year= 2012 | volume=  | issue=  | pages=  | pmid=23121323 | doi=10.1056/NEJMoa1211585 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23121323  }} </ref><ref name="pmid19228612">{{cite journal |author=Serruys PW, Morice MC, Kappetein AP, ''et al'' |title=Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease |journal=N. Engl. J. Med. |volume=360 |issue=10 |pages=961–72 |year=2009 |month=March |pmid=19228612 |doi=10.1056/NEJMoa0804626 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19228612&promo=ONFLNS19 |issn=}}</ref>
 
Clinical practice guidelines suggest that the [http://www.syntaxscore.com/ SYNTAX score] may help determine choice of procedure for myocardial revascularization.<ref name="pmid17437730">{{cite journal |author=Valgimigli M, Serruys PW, Tsuchida K, ''et al'' |title=Cyphering the complexity of coronary artery disease using the syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention |journal=Am. J. Cardiol. |volume=99 |issue=8 |pages=1072–81 |year=2007 |month=April |pmid=17437730 |doi=10.1016/j.amjcard.2006.11.062 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)00072-0 |issn=}}</ref>
*"Calculation of the Society of Thoracic Surgeons (STS) and SYNTAX scores is reasonable in patients with unprotected left main and complex CAD."<ref name="pmid22064601">{{cite journal|  author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek  B et al.| title=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. |  journal=Circulation | year= 2011 | volume=  | issue=  | pages=  |  pmid=22064601 | doi=10.1161/CIR.0b013e31823ba622 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064601  }} </ref>
* However, the more recent FREEDOM trial found the SYNTAX score did not predict benefit.<ref name="pmid23121323">{{cite journal| author=Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M et al.| title=Strategies for Multivessel Revascularization in Patients with Diabetes. | journal=N Engl J Med | year= 2012 | volume=  | issue=  | pages=  | pmid=23121323 | doi=10.1056/NEJMoa1211585 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23121323  }} </ref>
 
==Appropriateness of decisions for PTCA==
Less than half of patients with stable angina who receive PTCA are receiving optimal medical therapy.<ref name="pmid21558519">{{cite journal| author=Borden WB, Redberg RF, Mushlin AI, Dai D, Kaltenbach LA, Spertus JA| title=Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention. | journal=JAMA | year= 2011 | volume= 305 | issue= 18 | pages= 1882-9 | pmid=21558519 | doi=10.1001/jama.2011.601 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21558519  }} </ref>
 
Of patients without indications for myocardial revascularization, cardiologists will recommended [[percutaneous transluminal coronary angioplasty]]  for 21% of patients.<ref name="pmid20048207">{{cite journal|  author=Hannan EL, Racz MJ, Gold J, Cozzens K, Stamato NJ, Powell T et  al.| title=Adherence of catheterization laboratory cardiologists to  American College of Cardiology/American Heart Association guidelines for  percutaneous coronary interventions and coronary artery bypass graft  surgery: what happens in actual practice? | journal=Circulation | year=  2010 | volume= 121 | issue= 2 | pages= 267-75 | pmid=20048207 |  doi=10.1161/CIRCULATIONAHA.109.887539 | pmc= |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20048207  }} </ref> A second study found that 12% of elective [[percutaneous transluminal coronary angioplasty|percutaneous transluminal coronary angioplasties]] were done for inappropriate reasons.<ref name="pmid21730241">{{cite journal| author=Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K et al.| title=Appropriateness of percutaneous coronary intervention. | journal=JAMA | year= 2011 | volume= 306 | issue= 1 | pages= 53-61 | pmid=21730241 | doi=10.1001/jama.2011.916 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21730241  }} </ref>
 
Regarding drug eluting stents, about 50% of patients received them for off-label purposes.<ref name="pmid17488965">{{cite journal| author=Win HK, Caldera AE, Maresh K, Lopez J, Rihal CS, Parikh MA et al.| title=Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents. | journal=JAMA | year= 2007 | volume= 297 | issue= 18 | pages= 2001-9 | pmid=17488965 | doi=10.1001/jama.297.18.2001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17488965  }} </ref><ref name="pmid17488964">{{cite journal| author=Beohar N, Davidson CJ, Kip KE, Goodreau L, Vlachos HA, Meyers SN et al.| title=Outcomes and complications associated with off-label and untested use of drug-eluting stents. | journal=JAMA | year= 2007 | volume= 297 | issue= 18 | pages= 1992-2000 | pmid=17488964 | doi=10.1001/jama.297.18.1992 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17488964  }} </ref> Patients receiving stents for off-label indications have more adverse outcomes.<ref name="pmid17488965"/><ref name="pmid17488964"/>


==References==
==References==
<references/>
<references/>

Latest revision as of 22:38, 12 August 2015

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Main Article
Discussion
Related Articles  [?]
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This editable Main Article is under development and subject to a disclaimer.

In medicine, myocardial revascularization is "the restoration of blood supply to the myocardium."[1]

Revascularization procedures include:

Clinical practice guidelines address management and selection of patients.[5]

Elective percutaneous transluminal coronary angioplasty is not clearly better to optimal medical therapy.[6]

Coronary artery bypass is more effective for myocardial revascularization of coronary heart disease than percutaneous transluminal coronary angioplasty[7], especially for patients with diabetes who have stenosis of twocoronary arteries.[8][8][9] Coronary artery bypass is also more effective than percutaneous transluminal coronary angioplasty with drug-eluting stents; however, bypass may increase the rate of stroke.[8][10]

Clinical practice guidelines suggest that the SYNTAX score may help determine choice of procedure for myocardial revascularization.[11]

  • "Calculation of the Society of Thoracic Surgeons (STS) and SYNTAX scores is reasonable in patients with unprotected left main and complex CAD."[5]
  • However, the more recent FREEDOM trial found the SYNTAX score did not predict benefit.[8]

Appropriateness of decisions for PTCA

Less than half of patients with stable angina who receive PTCA are receiving optimal medical therapy.[12]

Of patients without indications for myocardial revascularization, cardiologists will recommended percutaneous transluminal coronary angioplasty for 21% of patients.[13] A second study found that 12% of elective percutaneous transluminal coronary angioplasties were done for inappropriate reasons.[14]

Regarding drug eluting stents, about 50% of patients received them for off-label purposes.[15][16] Patients receiving stents for off-label indications have more adverse outcomes.[15][16]

References

  1. Anonymous (2022), Myocardial revascularization (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Anonymous (2022), Coronary Artery Bypass (English). Medical Subject Headings. U.S. National Library of Medicine.
  3. Anonymous (2022), Percutaneous transluminal coronary angioplasty (English). Medical Subject Headings. U.S. National Library of Medicine.
  4. Anonymous (2022), Coronary Atherectomy (English). Medical Subject Headings. U.S. National Library of Medicine.
  5. 5.0 5.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al. (2011). "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.". Circulation. DOI:10.1161/CIR.0b013e31823ba622. PMID 22064601. Research Blogging. Cite error: Invalid <ref> tag; name "pmid22064601" defined multiple times with different content
  6. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ et al. (2007). "Optimal medical therapy with or without PCI for stable coronary disease.". N Engl J Med 356 (15): 1503-16. DOI:10.1056/NEJMoa070829. PMID 17387127. Research Blogging. Review in: ACP J Club. 2007 Jul-Aug;147(1):12 Review in: J Fam Pract. 2007 Jul;56(7):529 Review in: Evid Based Med. 2007 Aug;12(4):107
  7. Bravata DM, Gienger AL, McDonald KM, et al (2007). "Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Surgery". Ann Intern Med. PMID 17938385. [e]
  8. 8.0 8.1 8.2 8.3 Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M et al. (2012). "Strategies for Multivessel Revascularization in Patients with Diabetes.". N Engl J Med. DOI:10.1056/NEJMoa1211585. PMID 23121323. Research Blogging.
  9. (July 1996) "Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators". N. Engl. J. Med. 335 (4): 217–25. PMID 8657237. [e]
  10. Serruys PW, Morice MC, Kappetein AP, et al (March 2009). "Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease". N. Engl. J. Med. 360 (10): 961–72. DOI:10.1056/NEJMoa0804626. PMID 19228612. Research Blogging.
  11. Valgimigli M, Serruys PW, Tsuchida K, et al (April 2007). "Cyphering the complexity of coronary artery disease using the syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention". Am. J. Cardiol. 99 (8): 1072–81. DOI:10.1016/j.amjcard.2006.11.062. PMID 17437730. Research Blogging.
  12. Borden WB, Redberg RF, Mushlin AI, Dai D, Kaltenbach LA, Spertus JA (2011). "Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention.". JAMA 305 (18): 1882-9. DOI:10.1001/jama.2011.601. PMID 21558519. Research Blogging.
  13. Hannan EL, Racz MJ, Gold J, Cozzens K, Stamato NJ, Powell T et al. (2010). "Adherence of catheterization laboratory cardiologists to American College of Cardiology/American Heart Association guidelines for percutaneous coronary interventions and coronary artery bypass graft surgery: what happens in actual practice?". Circulation 121 (2): 267-75. DOI:10.1161/CIRCULATIONAHA.109.887539. PMID 20048207. Research Blogging.
  14. Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K et al. (2011). "Appropriateness of percutaneous coronary intervention.". JAMA 306 (1): 53-61. DOI:10.1001/jama.2011.916. PMID 21730241. Research Blogging.
  15. 15.0 15.1 Win HK, Caldera AE, Maresh K, Lopez J, Rihal CS, Parikh MA et al. (2007). "Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents.". JAMA 297 (18): 2001-9. DOI:10.1001/jama.297.18.2001. PMID 17488965. Research Blogging.
  16. 16.0 16.1 Beohar N, Davidson CJ, Kip KE, Goodreau L, Vlachos HA, Meyers SN et al. (2007). "Outcomes and complications associated with off-label and untested use of drug-eluting stents.". JAMA 297 (18): 1992-2000. DOI:10.1001/jama.297.18.1992. PMID 17488964. Research Blogging.