Browse the corpus

©2013 UpToDate ® Print Email ACC/AHA guideline summary: Coronary angiography for risk stratification in patients with chronic stable angina Class I - There is evidence and/or generalagreement that coronary angiography should be performed to riskstratify patients with chronic stable angina in the following settings •  Disabling anginal symptoms (Canadian Cardiovascular Society [CCS] classes III and IV) despite medical therapy. •  High-risk criteria on noninvasive testing independent of the severity of angina. •  Survivors of sudden cardiac death or serious ventricular arrhythmia. •  Symptoms and signs of heart failure. •  Clinical features that suggest that the patient has a high likelihood of severe coronary artery disease. Class IIa - The evidence oropinion is in favor of performing coronary angiography to risk stratifypatients with chronic stable angina in the following settings •  Left ventricular ejection fraction less than 45 percent, CCS class I or II angina, and evidence, on noninvasive testing, of ischemia that does not meet high-risk criteria. •  Noninvasive testing does not reveal adequate prognostic information. Class IIb - The evidence oropinion is less well established for performing coronary angiography torisk stratify patients with chronic stable angina in the followingsettings •  Left ventricular ejection fraction greater than 45 percent, CCS class I or II angina, and evidence, on noninvasive testing, of ischemia that does not meet high-risk criteria. •  CCS class III or IV angina that improves to class I or II with medical therapy. •  CCS class I or II angina but unacceptable side effects to adequate medical therapy. Class III - There is evidenceand/or general agreement that coronary angiography should not beperformed to risk stratify patients with chronic stable angina in thefollowing settings •  CCS class I or II angina that responds to medical therapy and, on noninvasive testing, shows no evidence of ischemia. •  Patient preference to avoid revascularization. Data from Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 2003; 107:149.