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GIBBONS ET AL., MANAGEMENT OF PATIENTS WITH CHRONIC STABLE ANGINA UPDATE
http://www.acc.org/clinical/guidelines/stable/update_index.htm

ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients With Chronic Stable Angina)


Committee Members
Jonathan Abrams, MD, FACC, FAHA; Kanu Chatterjee, MB, FACC; Jennifer Daley, MD, FACP; Prakash C. Deedwania, MD, FACC, FAHA; John S. Douglas, MD, FACC; T. Bruce Ferguson, Jr., MD; Stephan D. Fihn, MD, MPH, FACP; Theodore D. Fraker, Jr., MD, FACC; Julius M. Gardin, MD, FACC, FAHA; Robert A. O’Rourke, MD, FACC, FAHA; Richard C. Pasternak, MD, FACC, FAHA; Sankey V. Williams, MD, MACP

Task Force Members
Raymond J. Gibbons, MD, FACC, FAHA, Chair; Elliott M. Antman, MD, FACC, FAHA, Vice Chair; Joseph S. Alpert, MD, FACC, FAHA; David P. Faxon, MD, FACC, FAHA; Valentin Fuster, MD, PhD, FACC, FAHA; Gabriel Gregoratos, MD, FACC, FAHA; Loren F. Hiratzka, MD, FACC, FAHA; Alice K. Jacobs, MD, FACC, FAHA; Sidney C. Smith, Jr., MD, FACC, FAHA


Preamble

I. Introduction and Overview

  1. Organization of Committee and Evidence Review
  2. Scope of the Guidelines
  3. Overlap With Other Guidelines
  4. Magnitude of the Problem
  5. Organization of the Guidelines

II. Diagnosis

  1. History and Physical
    1. Definition of Angina
    2. Clinical Evaluation of Patients With Chest Pain
    3. Developing the Probability Estimate
    4. Generalizability of the Predictive Models
    5. Applicability of Models to Primary-Care Practices
  2. Associated Conditions
  3. Noninvasive Testing
    1. ECG/Chest X-Ray
    2. Exercise ECG for Diagnosis
    3. Echocardiography
    4. Stress Imaging Studies: Echocardiographic and Nuclear
  4. Invasive Testing: Value of Coronary Angiography
  5. Indications for Coronary Angiography
    1. Women
    2. The Elderly
    3. Coronary Spasm
    4. Coronary Anomaly
    5. Resuscitation From Ventricular Fibrillation or Sustained Ventricular Tachycardia

III. Risk Stratification

  1. Clinical Assessment
    1. Prognosis of CAD for Death or Nonfatal MI: General Considerations
    2. Risk Stratification With Clinical Parameters
  2. ECG/Chest X-Ray
  3. Noninvasive Testing
    1. Resting LV Function (Echocardiographic/Radionuclide Imaging)
    2. Exercise Testing for Risk Stratification and Prognosis
    3. Stress Imaging Studies (Radionuclide and Echocardiography)
  4. Coronary Angiography and Left Ventriculography
    1. Coronary Angiography for Risk Stratification in Patients With Chronic Stable Angina
    2. Risk Stratification With Coronary Angiography
    3. Patients With Previous CABG
    4. Asymptomatic Patients

IV. Treatment

  1. Pharmacologic Therapy
    1. Overview of Treatment
    2. Measurement of Health Status and Quality of Life in Patients With Stable Angina
    3. Pharmacotherapy to Prevent MI and Death
    4. Choice of Pharmacologic Therapy in Chronic Stable Angina
  2. Definition of Successful Treatment and Initiation of Treatment
    1. Successful Treatment
    2. Initial Treatment
    3. Asymptomatic Patients
  3. Education of Patients With Chronic Stable Angina
    1. Principles of Patient Education
    2. Information for Patients
  4. Coronary Disease Risk Factors and Evidence That Treatment Can Reduce the Risk for Coronary Disease Events
    1. Categorization of Coronary Disease Risk Factors
    2. Risk Factors for Which Interventions Have Been Shown to Reduce the Incidence of Coronary Disease Events
    3. Risk Factors for Which Interventions Are Likely to Reduce the Incidence of Coronary Disease Events
    4. Effects of Exercise Training on Exercise Tolerance, Symptoms, and Psychological Well-Being
    5. Risk Factors for Which Interventions Might Reduce the Incidence of Coronary Disease Events
    6. Risk Factors Associated With Increased Risk but That Cannot Be Modified or the Modification of Which Would Be Unlikely to Change the Incidence of Coronary Disease Events
    7. Other Proposed Therapies That Have Not Been Shown to Reduce Risk for Coronary Disease Events
    8. Asymptomatic Patients
  5. Revascularization for Chronic Stable Angina
    1. Coronary Artery Bypass Surgery
    2. Coronary Artery Bypass Grafting Versus Medical Management
    3. Percutaneous Coronary Intervention
    4. Patients With Previous Bypass Surgery
    5. Asymptomatic Patients

V. Patient Follow-Up: Monitoring of Symptoms and Antianginal Therapy

  1. Patients Not Addressed in This Section of the Guidelines
    1. Follow-up of Patients in the Following Categories Is Not Addressed By This Section of the Guidelines
    2. Level of Evidence for Recommendations on Follow-Up of Patients With Chronic Stable Angina

Staff

Appendix 1

References

Figures & Tables

This document was approved by the American College of Cardiology Foundation Board of Trustees in October 2002, the American Heart Association Science Advisory and Coordinating Committee in October 2002, and the Clinical Efficacy Assessment Subcommittee of the American College of Physicians-American Society of Internal Medicine in June 2002. When citing this document, please use the following citation format: Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr., Gardin JM, O'Rourke RA, Pasternak RC, Williams SV. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients with Chronic Stable Angina). 2002. Available at www.acc.org/clinical/guidelines/stable/stable.pdf.

This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org) and the American Heart Association (www.americanheart.org). Copies of this document are available by calling 1-800-253-4636 or writing the American College of Cardiology Foundation, Resource Center, at 9111 Old Georgetown Road, Bethesda, MD 20814-1699 Ask for reprint number 71-0243. To obtain a reprint of the Summary Article published in the January 1, 2003 issue of the Journal of the American College of Cardiology and the January 7/14, 2003 issue of Circulation, ask for reprint number 71-0244. To purchase bulk reprints (specify version and reprint number): Up to 999 copies, call 1-800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or e-mail pubauth@heart.org.

 

Copyright © 2002 by the American College of Cardiology and American Heart Association, Inc.

 

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