The Living Guidelines: Initial Conservative versus Initial Invasive Strategies in patients with Unstable Angina / Non ST Elevation MI Suggest Revisions to the CLASS III Guidelines

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Class III Guidelines
1. Percutaneous coronary intervention (or CABG) is not recommended for patients with one or two vessel coronary artery disease (CAD) without significant proximal left anterior descending CAD with no current symptoms or symptoms that are unlikely to be due to myocardial ischemia and who have no ischemia on noninvasive testing. (Class III Level of Evidence: C)

2. In the absence of high-risk features associated with UA / NSTEMI, PCI is not recommended for patients with UA / NSTEMI who have single vessel or multi vessel CAD and no trial of medical therapy, or who have one or more of the following:

a. Only a small area of myocardium at risk. (Class III Level of Evidence: C)

b. All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. (Class III Level of Evidence: C)

c. A high risk of procedure-related morbidity or mortality. (Class III Level of Evidence: C)

d. Insignificant disease (less than 50% coronary stenosis). (Class III Level of Evidence: C)

e. Significant left main CAD and candidacy for CABG. (Class III Level of Evidence: B)

3. A PCI strategy in stable patients with persistently occluded infarct related coronary arteries after STEMI / NSTEMI is not indicated. (Class III Level of Evidence: B)