1.What are the indications for coronary intervention?
A: I. Chronic stable coronary heart disease.
(1) There is objective evidence of a large range of myocardial ischemia;
(2) Routine stenting of the primary lesion of the autologous coronary artery;
(3) Primary lesions in venous bypass vessels are routinely stented;
(4) Chronic total occlusive lesions
(5) Patients at high surgical risk;
(6) Multi-vessel lesions without diabetes mellitus, lesions suitable for PCI;
(7) Multi-branch lesions combined with diabetes mellitus;
(7) selected unprotected left main lesions.
II. Patients with non-ST-segment elevation ACS.
(1) Emergency PCI in very high-risk patients (within 2 hours);
(2) PCI in early intermediate and high-risk patients (within 72 hours);
(3) Routine PCI is not recommended for low-risk patients;
(4) Routine stent placement for PCI patients.
Third, direct PCI in patients with STEMI
(1) All STEMI within 12 hours of onset and within 90 minutes of D-to-B time with experienced operator and team operation;
(2) Patients with contraindications to thrombolysis;
(3) PCI is more likely to be preferred >3 hours after onset;
(4) Cardiogenic shock, age <75 years, MI onset <36 hours, shock <18 hours;
(4) PCI may be considered on balance for selective cardiogenic shock at age >75 years with MI onset <36 hours and shock <18 hours;
(5) Evidence of ischemia at 12-24 hours of onset or with cardiac dysfunction or hemodynamic instability or severe arrhythmias;
(6) Direct PCI is not recommended for hemodynamically stable patients who dare to perform direct PCI in non-infarct-related arteries;
(7) Direct PCI is not recommended for asymptomatic, hemodynamically and electrocardiographically stable patients with >12 hours of onset;
(8) routine stent placement.
STEMI remedial PCI
(1) Persistent symptoms or manifestations of myocardial ischemia after 45-60 minutes of thrombolysis;
(2) combined cardiogenic shock, age <75 years with onset <36 hours and shock <18 hours
(3) Combined heart failure or pulmonary edema at 12 hours of onset;
(4) Age >75 years, cardiogenic shock, MI onset <36 hours, shock <18 hours, remedial PCI is feasible after weighing the pros and cons;
(5) Hemodynamic instability or electrical instability.
Elective PCI.
(1) The lesion is suitable for PCI and shows signs of recurrent MI;
(2) lesions suitable for PCI with manifestations of spontaneous or induced ischemia;
(3) lesions suitable for PCI with cardiogenic shock or hemodynamic instability;
(4) LVEF <40%, heart failure, severe ventricular arrhythmias, and routine PCI;
(5) PCI for severe stenosis in the IRA without spontaneous or induced ischemia, 24 hours after onset;
(6) Complete occlusion of the IRA. Routine PCI 24 hours after onset is not recommended for asymptomatic 1-2 vessel lesions without severe ischemic manifestations and hemodynamic and electrocardiographic stability.