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ACC/AHA Guidelines for Coronary Angiography Journal of the American College of Cardiology Vol. 33, No. 6, 1999 © 1999 by the American College of Cardiology and the American Heart Association, Inc. ISSN 0735-1097/99/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00126-6 ACC/AHA PRACTICE GUIDELINES ACC/AHA Guidelines for Coronary Angiography A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) Developed in collaboration with the Society for Cardiac Angiography and Interventions COMMITTEE MEMBERS PATRICK J. SCANLON, MD, FACC, Co-Chair and DAVID P. FAXON, MD, FACC, Co-Chair ANNE-MARIE AUDET, MD, MSC, SM, FACP DONALD F. LEON, MD, FACC BLASE CARABELLO, MD, FACC JOHN A. MURRAY, MD, FACC GREGORY J. DEHMER, MD, FACC STEVEN E. NISSEN, MD, FACC KIM A. EAGLE, MD, FACC CARL J. PEPINE, MD, FACC RONALD D. LEGAKO, MD, FAAFP RITA M. WATSON, MD, FACC TASK FORCE MEMBERS JAMES L. RITCHIE, MD, FACC, Chair and RAYMOND J. GIBBONS, MD, FACC, Vice Chair MELVIN D. CHEITLIN, MD, FACC RICHARD O. RUSSELL, JR, MD, FACC KIM A. EAGLE, MD, FACC THOMAS J. RYAN, MD, FACC TIMOTHY J. GARDNER, MD, FACC SIDNEY C. SMITH, JR, MD, FACC ARTHUR GARSON, JR, MD, MPH, FACC TABLE OF CONTENTS II. General Considerations Regarding Coronary Angiography..............................................................................1759 Preamble .............................................................................................1757 A. Definitions ..........................................................................1759 I. Introduction...............................................................................1758 B. Purpose ................................................................................1759 C. Morbidity and Mortality .................................................1760 D. Relative Contraindications..............................................1760 “ACC/AHA Guidelines for Coronary Angiography” was approved by the Amer- E. Utilization ...........................................................................1761 ican College of Cardiology Board of Trustees in October 1998 and by the American Heart Association Science Advisory and Coordinating Committee in December 1998. F. Costs ....................................................................................1763 When citing this document, the American College of Cardiology and the G. Cost-Effectiveness.............................................................1764 American Heart Association request that the following format be used: Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, Legako RD, Leon DF, III. Coronary Angiography for Specific Conditions ...............1764 Murray JA, Nissen SD, Pepine CJ, Watson RM. ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart A. Known or Suspected CAD.............................................1764 Association Task Force on Practice Guidelines (Committee on Coronary Angiogra- 1. General Considerations .............................................1764 phy). J Am Coll Cardiol 1999;33:1756–824 2. Stable Angina...............................................................1765 This document is available on the websites of the ACC (www.acc.org) and the a. Definitions ..............................................................1765 AHA (www.americanheart.org). Reprints of this document (the complete guidelines) are available for $5 each by calling 800-253-4636 (US only) or writing the American b. Management Approach for Symptomatic College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, Patients ....................................................................1766 MD 20814-1699. Ask for reprint No. 71-0164. To obtain a reprint of the shorter c. Management Approach for Asymptomatic or version (executive summary and summary of recommendations) published in the May Mildly Symptomatic Patients With Known or 4, 1999, issue of Circulation, ask for reprint No. 71-0163. To purchase additional Suspected CAD.....................................................1766 reprints (specify version and reprint number): up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax d. Management Approach for Patients Resuscitated 214-691-6342, or e-mail [email protected] From Sudden Cardiac Death.............................1768 JACC Vol. 33, No. 6, 1999 Scanlon and Faxon 1757 May 1999:1756–824 ACC/AHA Coronary Angiography Guidelines e. Management of Patients With Nonspecific Chest Appendix B. Pain...........................................................................1770 Special Considerations Regarding Coronary 3. Unstable Angina..........................................................1771 Angiography ..............................................................................1792 a. Definitions ..............................................................1771 1. Accuracy ........................................................................1792 b. Pathophysiology.....................................................1771 2. Reproducibility.............................................................1792 c. Risk Stratification..................................................1771 3. Digital Imaging of Coronary Angiography ..........1793 d. Prognosis .................................................................1771 a. The DICOM Standard .......................................1794 e. Management Approach .......................................1771 4. Limitations....................................................................1794 4. Recurrence of Symptoms After 5. Contrast Agents...........................................................1795 Revascularization .........................................................1773 a. Selection of a Contrast Agent for Coronary a. Definitions ..............................................................1773 Angiography ...........................................................1795 b. Recurrence of Symptoms After Catheter-Based 6. Pharmacologic Assessment of Coronary Spasm ..1796 Revascularization ...................................................1773 a. Coronary Artery Spasm.......................................1796 (1) Abrupt Closure After Catheter-Based b. Provocative Testing for Spasm ..........................1796 Revascularization............................................1773 (2) Periprocedural Enzyme Elevation .............1774 Appendix C. (3) Restenosis ........................................................1774 Alternative Imaging Modalities ............................................1797 c. Recurrence of Symptoms After Coronary Artery 1. Coronary Intravascular Ultrasound .........................1797 Bypass Surgery .......................................................1774 2. Intracoronary Doppler Ultrasound..........................1799 5. Acute MI ......................................................................1775 3. Coronary Angioscopy.................................................1802 a. Introduction............................................................1775 4. Fractional Flow Reserve ............................................1803 b. Definitions ..............................................................1776 c. Coronary Angiography During the Initial Appendix D. Management of Patients in the Emergency Canadian Cardiovascular Society Classification of Angina Department.............................................................1776 Pectoris .......................................................................................1803 (1) Patients Presenting With Suspected MI and Appendix E. ST-Segment Elevation or Bundle-Branch Elements of a Coronary Angiographic Report .................1803 Block.................................................................1776 References...........................................................................................1804 (a) Coronary Angiography Immediately Index....................................................................................................1817 After Thrombolytic Therapy ..............1777 (b) Coronary Angiography With Primary Angioplasty for Acute MI ...................1778 PREAMBLE (2) Patients Presenting With Suspected MI but Without ST-Segment Elevation................1780 It is important that the medical profession play a significant d. Hospital Management Phase of Acute MI ....1781 role in critically evaluating the use of diagnostic procedures (1) Concepts Common to All Patients With and therapies in the management and prevention of disease MI .....................................................................1781 states. Rigorous and expert analysis of the available data (2) Patients With Q-Wave Infarction Treated documenting relative benefits and risks of those procedures With Thrombolytics .....................................1782 and therapies can produce helpful guidelines that improve (3) Patients Treated With Primary the effectiveness of care, optimize patient outcomes, and Angioplasty .....................................................1782 have a favorable effect on the overall cost of care by focusing (4) The “Open Artery Hypothesis” .................1783 resources on the most effective strategies. (5) Patients With Non–Q-Wave Infarction..1783 e. Risk Stratification Phase in Preparation for The American College of Cardiology (ACC) and the Discharge From the Hospital After MI..........1784 American Heart
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