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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA hallmark of the efficacy of percutaneous coronary interventions (PCI) is reflected in the extraordinary rise in number of procedures performed in the last decade. Stent insertion in the U.S. alone jumped by 150% in that period, and more than doubled among older patients. The data now supports what clinicians see in daily practice: PCI improves outcomes, extends life\u2014and quality of life\u2014as it reduces indirect costs of disability (lost work time, decreased productivity, etc.)\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eguidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EA hallmark of the efficacy of percutaneous coronary interventions (PCI) is reflected in the extraordinary rise in number of procedures performed in the last decade. Stent insertion in the U.S. alone jumped by 150% in that period, and more than doubled among older patients. The data now supports what clinicians see in daily practice: PCI improves outcomes, extends life\u2014and quality of life\u2014as it reduces indirect costs of disability (lost work time, decreased productivity, etc.)\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe guidelines, last revised in 2001, now reflect emerging insights from clinical trials, changing levels of evidence (and the growing sophistication in applying the standards of evidence-based medicine), and evolving expert consensus.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAmong the central goals of guideline revision is promotion of the \u201c90 minutes from door-to-balloon\u201d concept, according to Sidney C. Smith, Jr., MD, Director of the Center for Cardiovascular Science and Medicine at the University of North Carolina at Chapel Hill, and chair of the ACC\/AHA PCI writing committee. Current state-of-the-science demonstrates that patients truly benefit from rapid access to PCI, Dr. Smith said. \u201cWe have consistently looked at where the science says we should be, and challenged ourselves.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAmong the revisions there are a number of pivotal new guidelines, cited here with class of ACC\/AHA recommendation (ranked by Roman numerals) and level of evidence (ranked alphabetically).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003E\n            \u003Cstrong\u003EMeasure troponins in patients with MI during\/after PCI. And follow-up, as a routine, with biomarker levels 8\u201312 hours post-procedure.\u003C\/strong\u003E These recommendations reflect new knowledge of the role of troponins and revise the earlier guideline which made no mention of troponins and offered no recommendation for post-procedure biomarker follow-up (Class I\/level of evidence B).\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\n            \u003Cstrong\u003EEarly PCI for UA\/NSTEMI patients is recommended.\u003C\/strong\u003E This guideline is now consistent with the ACC\/AHA 2002 UA\/NSTEMI guidelines, and encompasses patients with recurrent ischemia despite treatment and\/or other markers of CV instability (Class I\/level of evidence A).\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003E\n            \u003Cstrong\u003EAdminister a pre-PCI loading dose of clopidogrel.\u003C\/strong\u003E Strong evidence of efficacy supports a 300 mg loading dose of clopidogrel given at least 6 hours before PCI. Clopidogrel should then be continued at 75 mg daily in all patients receiving stents (Class I\/Level of evidence A\/B).\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003E(Duration of therapy varies based on specific stent implanted. See: \u003Ca href=\u0022http:\/\/www.acc.org\/clinical\/guidelines\/percutaneous\/update\/PCIPocketGuideupdate.pdf\u0022\u003Ehttp:\/\/www.acc.org\/clinical\/guidelines\/percutaneous\/update\/PCIPocketGuideupdate.pdf\u003C\/a\u003E)\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003E\n            \u003Cstrong\u003ELow-molecular-weight heparin is a \u201creasonable alternative\u201d to unfractionated heparin in UA\/NSTEMI and STEMI patients undergoing PCI.\u003C\/strong\u003E Although carrying slightly lower levels of evidence, this recommendation reflects advances in anticoagulation pharmacology (Class IIa\/level of evidence B).\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003E\n            \u003Cstrong\u003ECardiac care centers must either institute or improve peer review and quality assurance programs.\u003C\/strong\u003E As PCI has increased in both numbers of procedures performed and numbers of centers performing PCI, the need is now paramount to monitor operator skill and performance as well as institutional track records. The new guidelines recommend that elective PCI be performed by operators who perform \u0026gt;75 procedures a year in centers where at least 400 procedures are conducted annually (Class I\/level of evidence B). Centers are encouraged to establish rigorous review of quality and outcomes, participate in national data registries, and measure in-house statistics against national benchmarks (Class I\/level of evidence B).\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\u201cThese guidelines have applications\u2014and implications\u2014far beyond the practice of interventional cardiology,\u201d said William W. O\u0027Neill, MD, chairman of cardiology for the William Beaumont Hospital System in Royal Oak, MI. \u201cIt\u0027s imperative that physicians and hospital administrators carefully review the guidelines,\u201d Dr. O\u0027Neill said, both for implementing practice standards and \u201cbecause [these guidelines] may be used to grade performance\u201d in the future.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003E\n            \u003Ca href=\u0022http:\/\/www.acc.org\/clinical\/guidelines\/percutaneous\/update\/index_summaryupdate.pdf\u0022\u003Ehttp:\/\/www.acc.org\/clinical\/guidelines\/percutaneous\/update\/index_summaryupdate.pdf\u003C\/a\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2005 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/5\/1\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm4g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}