Document Detail

Angiography is the gold standard and objective evidence of myocardial ischemia is mandatory if lesion severity is questionable. - Indication of PCI for angiographically significant coronary artery stenosis without objective evidence of myocardial ischemia (Pro)-.
MedLine Citation:
PMID:  21173507     Owner:  NLM     Status:  MEDLINE    
The indications for percutaneous coronary intervention (PCI) have expanded, especially after the approval of drug-eluting stents, for both complex lesions and those with intermediate stenosis. Because recent randomized trials have demonstrated the non-inferiority of optimal medical treatment for stable angina compared with coronary revascularization, and the benefits of PCI guided by coronary pressure measurement have been shown in another trial, the appropriateness of current indications for CI has been called into question. In the evaluation of coronary artery stenosis, inter- and intraobserver variabilities can be problematic. Therefore, the use of PCI for intermediate coronary stenosis based on angiographic evaluation alone without documentation of myocardial ischemia could be questionable. Guidelines mention that physiological assessment of myocardial ischemia is most useful in patients with intermediate coronary artery stenosis, while interobserver differences in the assessment of severe stenosis are usually small.Accordingly, routine provocation testing for myocardial ischemia before PCI maybe less than ideal for real-world practice, and the indications for PCI should be multifactorial. 
Masato Nakamura
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Publication Detail:
Type:  Comment; Journal Article    
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  75     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2011  
Date Detail:
Created Date:  2011-01-14     Completed Date:  2011-02-25     Revised Date:  2012-01-09    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  204-10; discussion 217     Citation Subset:  IM    
Department of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan.
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MeSH Terms
Angioplasty, Balloon, Coronary*
Coronary Angiography*
Coronary Stenosis / complications,  physiopathology,  radiography*,  therapy
Fractional Flow Reserve, Myocardial
Myocardial Ischemia / etiology,  physiopathology,  radiography*,  therapy
Observer Variation
Patient Selection
Practice Guidelines as Topic
Predictive Value of Tests
Reproducibility of Results
Severity of Illness Index
Comment On:
Circ J. 2011;75(1):211-7; discussion 210   [PMID:  21173503 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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