SCAI Publishes Consensus Statement on Ad Hoc PCI

November 29, 2012—Recommendations published online ahead of print by James C. Blankenship, MD, et al in Catheterization and Cardiovascular Interventions provide new guidance on when physicians should move forward to open a blocked artery with ad hoc percutaneous coronary intervention (PCI) versus when to stop the test for further discussion with the patient or consultation with a heart surgeon, announced the Society for Cardiovascular Angiography and Interventions (SCAI).

“Patients tend to love the idea of ‘a quick fix' for problems. They may even demand to have their heart artery blockages fixed as soon as we find them, but doctors are increasingly realizing that treatment decisions are sometimes better made after some thought. Whether we proceed immediately or stop the procedure depends on the individual patient's situation,” Dr. Blankenship commented in the SCAI press release. “When a patient is suffering a heart attack, or the angiogram reveals that a heart attack may be imminent, immediate angioplasty and stenting is almost always in the patient's best interest. In contrast, when the patient's blockages appear to be stable, it may be advisable to stop the procedure and discuss the test results with the patient and family members. The new recommendations will help physicians ensure they are taking the right steps to provide the best care for each patient.”

According to the recommendations published in Catheterization and Cardiovascular Interventions, ad hoc PCI should be performed only as part of a comprehensive program that includes a patient consent process that involves the patient in shared decision making prior to sedation and fully informs them of the risks and benefits of ad hoc PCI and alternative treatments; data collection to determine appropriateness, including severity of angina, ischemia, and the patient's past experience with medications; patient risk assessment, including short- and long-term risks of both PCI and alternative treatments, such as medications and cardiac surgery; administration of proper drugs and fluids to pre-treat patients who may be candidates for ad hoc PCI; and, appropriate scheduling to allow time for ad hoc PCI.

According to SCAI's press release, the consensus statement also helps guide physicians on how to use ad hoc PCI to treat patients with various heart conditions, noting that ad hoc PCI is the best treatment for heart attack patients. For stable heart disease, ad hoc PCI should be considered, and has the greatest benefit, when the best available medications have failed and large sections of the heart are threatened. For patients who have not tried medications, the benefits of ad hoc PCI should be compared with those of medications.

The document states that for the most complex heart artery blockages, ad hoc PCI should be reserved for unusual circumstances when surgery is not an option and the patient is aware of benefits and risks associated with the procedure.

Because patients sometimes prefer treatments that are convenient, rather than a treatment that may be safer, physicians and these patients should work together to make the best choice for the individual patient, advised the statement.