Risks stratification and benefits of PCI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Xin Yang, MA(Cantab), MB BChir, MRCP(Lond) Anahita Deylamsalehi, M.D.[2]

Overview

There are several risk assessment scores which can help in determining a patient’s risk for death, myocardial infarction and recurrent cardiac events.

Risks Stratification and Benefits of PCI

Risk Score Assessment

The TIMI Risk Score for STEMI

The TIMI Risk Score for UA/NSTEMI

The GRACE Risk Score

Risk Stratification Tools

Risk Stratification in the Patient with Stable Angina

Risk Stratification in the Patient with Unstable Angina or Non ST Elevation MI

Risk Stratification in the Patient with ST Elevation MI

Benefits of PCI vs Medical Therapy

In Patients With Stable Angina

In Patients With Unstable Angina or Non ST Elevation MI

In Patients With ST Elevation MI

Benefits of Rescue PCI

Studies demonstrated that rescue PCI after failed fibrinolytic therapy is related to a lower risk of cardiovascular events when compared to repeated fibrinolytic therapy or conservative managements.^[1]^[2]^[3]^[4]

However, rates of complications such as stroke and bleeding were higher in the rescue PCI group.^[1]^[2]
On the other hand, the fact that those studies have been done in the era of femoral artery access and limited antiplatelet and anticoagulant therapies may explain the higher rates of stroke and bleeding.^[4]
Half-dose tenecteplase in patients older than 75 years old reduces the risk of stroke.^[5]
Furthermore, radial artery access instead of femoral artery or avoiding routine use of glycoprotein IIb/IIIa inhibitors could be used to decrease the risk of bleeding.^[6]

References

↑ ^1.0 ^1.1 Sutton AG, Campbell PG, Graham R, Price DJ, Gray JC, Grech ED; et al. (2004). “A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: the Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial”. J Am Coll Cardiol. 44 (2): 287–96. doi:10.1016/j.jacc.2003.12.059. PMID 15261920.
↑ ^2.0 ^2.1 Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO; et al. (2007). “Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials”. J Am Coll Cardiol. 49 (4): 422–30. doi:10.1016/j.jacc.2006.09.033. PMID 17258087. Review in: ACP J Club. 2007 Jul-Aug;147(1):11
↑ Collet JP, Montalescot G, Le May M, Borentain M, Gershlick A (2006). “Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy”. J Am Coll Cardiol. 48 (7): 1326–35. doi:10.1016/j.jacc.2006.03.064. PMID 17010790.
↑ ^4.0 ^4.1 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
↑ Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y; et al. (2013). “Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction”. N Engl J Med. 368 (15): 1379–87. doi:10.1056/NEJMoa1301092. PMID 23473396.
↑ Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J; et al. (2018). “An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association”. Circ Cardiovasc Interv. 11 (9): e000035. doi:10.1161/HCV.0000000000000035. PMID 30354598.

Template:WikiDoc Sources

[pmid15261920-1] 1.0 ^1.1 Sutton AG, Campbell PG, Graham R, Price DJ, Gray JC, Grech ED; et al. (2004). “A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: the Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial”. J Am Coll Cardiol. 44 (2): 287–96. doi:10.1016/j.jacc.2003.12.059. PMID 15261920.

[pmid17258087-2] 2.0 ^2.1 Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO; et al. (2007). “Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials”. J Am Coll Cardiol. 49 (4): 422–30. doi:10.1016/j.jacc.2006.09.033. PMID 17258087. Review in: ACP J Club. 2007 Jul-Aug;147(1):11

[pmid17010790-3] Collet JP, Montalescot G, Le May M, Borentain M, Gershlick A (2006). “Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy”. J Am Coll Cardiol. 48 (7): 1326–35. doi:10.1016/j.jacc.2006.03.064. PMID 17010790.

[pmid34895950-4] 4.0 ^4.1 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).

[pmid23473396-5] Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y; et al. (2013). “Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction”. N Engl J Med. 368 (15): 1379–87. doi:10.1056/NEJMoa1301092. PMID 23473396.

[pmid30354598-6] Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J; et al. (2018). “An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association”. Circ Cardiovasc Interv. 11 (9): e000035. doi:10.1161/HCV.0000000000000035. PMID 30354598.

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