6 Key Changes

Six key areas have been identified and are now incorporated into the updated guidelines, Dr. Smith said. Drug-eluting stents is one, and the guidelines identify diabetics as a group that benefits in particular from stent placement.

Second, operator volume has been identified as pivotal in PCI outcome, with an annual operator volume of 75 procedures per year, including 11 emergent PCIs per year, as a critical cut-off number for best proficiency.

Third, the guidelines recommend that elective PCI be performed only at centers with cardiac surgery facilities onsite.

The guidelines identify the left main coronary artery as having particular significance, with PCI "reasonable to perform [on the left main] in patients not eligible for bypass surgery," Dr. Smith said.

A fifth highlight of the updated guidelines is the recommendation for distal protection with stent placement, which "dramatically improves the safety of stent procedures."

A sixth addition to the guidelines is a set of recommendations for patient care after PCI, and includes the use of platelet inhibition for at least a year and implementation of target levels of LDL cholesterol below 70 mg/dl. Dr. Smith said these new recommendations may be rapidly outdated with results of a major clinical study of post-PCI patient management anticipated for spring.