The Living Guidelines: UA/NSTEMI Recommendations for PCI 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 1 or 2 vessel 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. (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. (Level of Evidence: C)
 * b. All lesions or the culprit lesion to be dilated with morphology that conveys a low likelihood of success. (Level of Evidence: C)
 * c. A high risk of procedure related morbidity or mortality. (Level of Evidence: C)
 * d. Insignificant disease (<50% coronary stenosis). (Level of Evidence: C)
 * e. Significant left main CAD and candidacy for CABG. (Level of Evidence: B)

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