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Chest Pain / Angina Pectoris: Difference between revisions
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<small>''Class I:'' Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective. ''Class II:'' | <small>''Class I:'' Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective. ''Class II:'' | ||
Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure. ''IIa:'' Weight of evidence/opinion is in favour of usefulness/efficacy. ''IIb:'' Usefulness/efficacy is less well established by evidence/opinion. ''Class III'': Evidence or general agreement that the given treatment or procedure is not usefull effective, and in some cases may be harmful.</small> | Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure. ''IIa:'' Weight of evidence/opinion is in favour of usefulness/efficacy. ''IIb:'' Usefulness/efficacy is less well established by evidence/opinion. ''Class III'': Evidence or general agreement that the given treatment or procedure is not usefull effective, and in some cases may be harmful.</small> | ||
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{| class="wikitable" border="1" style="width: 700px" | |||
|- | |||
! style="background: #34abff; color: white; " | Class of recommendations | |||
! style="background: #34abff; color: white" | ACC AHA angio stable angina | |||
|- | |||
| style="background: #74fb3f; vertical-align:top;" | '''Class I''' | |||
| style="background: white" | There is evidence and/or general agreement that coronary angiography should be performed to risk stratify 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. | |||
|- | |||
| style="background: #fdaa02; vertical-align:top;" | '''Class IIa''' | |||
| style="background: white" | The evidence or opinion is in favor of performing coronary angiography to risk stratify patients 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. | |||
|- | |||
| style="background: #fdaa02; vertical-align:top;" | '''Class IIb''' | |||
| style="background: white" | The evidence or opinion is less well established for performing coronary angiography to risk stratify patients with chronic stable angina in the following settings | |||
#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. | |||
|- | |||
| style="background: #fd3535; vertical-align:top;" | '''Class III''' | |||
| style="background: white" | There is evidence and/or general agreement that coronary angiography should not be performed to risk stratify patients with chronic stable angina in the following 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. | |||
|- | |||
| colspan="2" | | |||
<small>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.</small> | |||
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