ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina—Summary Article

Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women

“…Exercise ECG is considered the initial test of choice in women with suspected CAD [3], which is based on a large number of studies demonstrating its utility for the detection of CAD. In a meta-analysis including 19 exercise ECG studies with 3721 women the mean sensitivity was 61%, and mean specificity was 70%.…”

“…In patients with stenosis >40% determined visually by the consensus of two experienced cardiologists, computer-assisted quantification of luminal diameter stenosis (QCA) was performed (except for subtotal stenosis). Significant CAD was defined as ≥70% narrowing of the luminal diameter in at least one projection of at least one major epicardial artery, or ≥50% narrowing of the left main [3]. Additionally, we evaluated detection of at least intermediate grade stenoses by applying a cutoff of ≥50%.…”

“…Based on assessment of symptoms and risk factors, the majority of women being evaluated for chest pain syndromes have an intermediate pre-test probability of CAD. In this group of patients accurate noninvasive tests are an indispensable component in the diagnostic work-up [3]. However, well-established noninvasive tests for the diagnosis of CAD all have substantial limitations in women in predicting significant angiographic CAD [4].…”

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

“…In some cases, careful consideration will lead to a single-vessel PCI with other lesions managed medically; in other cases, such consideration leads to multivessel PCI in the same procedure or in multiple stages. Although guidelines and appropriate use criteria (AUC) provide guidance regarding PCI for multivessel disease, none of these documents offer comprehensive recommendations for onestage versus multistage approaches [1][2][3]. The purpose of this article is to offer guidance regarding the selection of optimal PCI strategies in patients with multivessel disease.…”

“…Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing.…”