November 18, 2011 – The first comprehensive report to review timing of treatment for patients with blockages in more than one coronary artery recommends a flexible approach that meets individual patient’s needs. The report was issued today by the Society for Cardiovascular Angiography and Interventions (SCAI) and is published online in Catheterization and Cardiovascular Interventions.
Up to half of all patients with coronary artery disease have blockages in more than more artery. As many as one in five percutaneous coronary intervention (PCI) patients receives treatment in more than one vessel. SCAI’s new clinical document reviews treatment options for these patients and provides recommendations for treatment of multiple vessels in one stage or in multiple stages.
“When multiple arteries are treated it is usually done in one session, which may not be the safest approach,” said James C. Blankenship, M.D., FSCAI, lead author of the new document. “Yet interventional cardiologists have not had comprehensive recommendations on when it is better to split the treatment of several arteries into two sessions. Splitting the procedure into separate sessions is less convenient for patients and more costly to insurers. Thus cardiologists may feel pressured into doing too much in one session. That can be dangerous for some patients. With this document, SCAI provides guidance for treating these patients and ensuring every step of the procedure is as safe as possible and appropriate for each patient’s individual health condition.”
The report makes several recommendations for treating multi-vessel coronary artery disease patients, including:
· Give all PCI patients the best medical therapy, ideally starting before PCI.
· Treat multiple vessels during diagnostic procedures only if the patient knows the risks and benefits.
· Start with a strategy for which blockages to treat and which to treat first to get the best outcomes.
· Change the treatment strategy in mid-procedure if the patient’s condition changes.
· Re-evaluate the need for additional treatment at each stage of the procedure.
“Recent research studies have changed our understanding of which patients are best treated with medications, bypass surgery or coronary artery stenting. We have to translate these scientific studies into guidelines that help doctors treat their patients,” said Blankenship. “This report will help interventional cardiologists provide the best treatment to improve each patient’s health.”
“Society for Cardiovascular Angiography and Interventions (SCAI) Clinical Document: Staging of Multi-Vessel Percutaneous Coronary Interventions” will be published at http://onlinelibrary.wiley.com/doi/10.1002/ccd.23353/abstract.