Diabetes: Documented in medical record or by patient history. Diabetes without sequelae: On oral hypoglycemic or insulin. Diabetes with sequelae: Renal disease, retinopathy, peripheral neuropathy, gastroparesis, peripheral circulatory disease.
Vascular Disease (PVD): cerebrovascular=prior CVA, prior TIA, carotid stenosis by history or carotid bruit; low(er) ext(remity)=claudication, amputation, prior lower extremity bypass, absent pedal pulses, or lower extremity ulcers.
COPD: COPD or asthma requiring inhalers, theophyllines/aminophyllines or steroids.
Renal failure prior to PCI: On peritoneal or hemodialysis.
CHF prior to PCI: MD statement in chart indicating CHF during admission or prior to admission but before the PCI. Manifest by >=1 feature including exertional dyspnea or fatigue, bilateral pedal edema, orthopnea, PND, rales, pulmonary edema, or pulmonary congestion on x-ray.
Asymptomatic CAD: Patient has no symptoms off medication but a) is s/p cardiac arrest in the absence of an MI or b) has severe ischemia on medication as manifest by > 1 mm ST depression or > 1 reversible thallium defect(s) or reduction in ejection fraction at low level exercise.
Stable angina: Patient is asymptomatic only when treated with anti-anginal medication or has a stable pattern of symptoms when treated with anti-anginal medication, but angina significantly interferes with quality of life or medication is poorly tolerated.
Unstable angina: New onset angina, rest angina, angina of increasing frequency and/or intensity, angina lasting >20 minutes irrespective of medication, not occurring within 2 weeks of an MI.
Post-infarction angina: Angina with ischemic EKG changes and/or CHF at >24 hours but <2 weeks after a documented MI.
Post-infarction anatomy: Patient has a significant residual lesion in an infarct-related artery that is not causing angina and/or CHF.
Therapy for a non-Q wave or ST elevation MI: PCI within 24 hours of an MI documented biochemically by a) Troponin T or I greater than decision limit; b) CK-MB >2x normal on one occasion or >normal on two occasions; c) total CK>2x normal AND ischemic symptoms and/or development of pathological Q waves and/or ECG changes of ischemia.
Cardiogenic shock: BP less than 80 mmHg requiring treatment with pressors and/or inotropes.
Priority: Emergent: factors dictate PCI be performed immediately to avoid unnecessary morbidity or death; Urgent: factors require that patient stay in hospital until PCI is performed. The risk of immediate morbidity and mortality is not present; Non-urgent: factors indicate that patient could be discharged to return electively for PCI.
ACC Type C lesion: Diffuse (>2 cm length); excess proximal tortuosity; extreme angulation >90°; unable to protect major side branches; total occlusion >3 mo.; degenerative vein grafts with friable lesions.