The guidelines go on to state that completion of ongoing clinical trials will be required before it's known whether PCI is also appropriate for left main disease in good candidates for coronary artery bypass graft, according to Ted Feldman, M.D., professor of medicine at Northwestern University, Chicago, and past president of the Society for Cardiovascular Angiography and Interventions (SCAI), which developed the new PCI guidelines together with the AHA and ACC.
▸ Distal embolic protection devices. These devices have been declared essential whenever technically feasible in patients undergoing PCI of saphenous vein grafts. However, the devices haven't as yet been shown to be beneficial in patients undergoing primary PCI for acute MI.
▸ An expanded role for interventionalists in postprocedural patient management. Aggressive LDL-cholesterol lowering to a target below 70 mg/dL is recommended in very high risk patients. The guidelines also emphasize the role of specific antiplatelet regimens involving aspirin plus clopidogrel, as well as the use of ACE inhibitor and β-blocker therapy. And all diabetic patients need to have an hemoglobin A1c below 7%.
“Interventional cardiologists are already awfully busy, and we don't expect them to take on the management of diabetes. But Hb A1c is a pretty good indicator of diabetic control, and it's an easy test for the interventional cardiologist to draw in the hospital. If better control is needed, they can refer the patient back to the primary care physician. We really think it's an opportunity for the interventionalist to get the patient off in the right direction,” Dr. Smith said.
The full 122-page guidelines with their 109 recommendations are available on the Web sites of the ACC (www.acc.orgwww.my.americanheart.orgwww.scai.org