Clinical UM Guideline

 

Subject: Elective Percutaneous Coronary Interventions (PCI)
Guideline #:  CG-SURG-48 Publish Date:    08/29/2018
Status: Reviewed Last Review Date:    07/26/2018

Description

This document addresses percutaneous coronary interventions (PCI), which is a term that primarily refers to percutaneous transluminal coronary angioplasty (PTCA), performed with or without coronary stent implantation, and atherectomy for the treatment of coronary artery disease (CAD). Notably, this document is intended to address PCI when done as an elective, non-emergent, primarily outpatient procedure, and not as part of an emergent inpatient coronary intervention for acute coronary syndrome (ACS). 

Note: For information related to other technologies associated with cardiac disease evaluation or management, see:

Clinical Indications

Medically Necessary:

Percutaneous coronary interventions (PCI) may include the following percutaneous procedures when criteria are met:

  1. Percutaneous transluminal coronary angioplasty (PTCA) with or without stent implantation;
  2. Intracoronary atherectomy.

Percutaneous coronary interventions (PCI) are considered medically necessary when ANY of the following criteria are met (A, B, C, or D):

  1. As an alternative to coronary artery bypass grafting (CABG), in stable individuals with significant (greater than or equal to 50% diameter) coronary artery stenoses in unprotected left main CAD* with BOTH of the following (1 and 2):
    1. Anatomic conditions associated with a low risk of PCI procedural complications and a high likelihood of good long-term outcome (for example, a low SYNTAX* score [less than or equal to 22], ostial or trunk left main CAD); and
    2. Clinical characteristics that predict a significantly increased risk of adverse surgical outcomes from CABG (for example, STS-predicted* risk of operative mortality greater than or equal to 5%); or 
  2. Symptomatic individuals with 1 or more significant (greater than or equal to 70% diameter) coronary artery stenoses when amenable to revascularization and with Class II, III or IV angina (see table 1) that persists despite maximal guideline-directed medical therapy (GDMT*) or who have a contraindication to, or are intolerant of maximal GDMT; or
  3. Symptomatic individuals with 1 or more significant (greater than or equal to 70% diameter) coronary artery stenoses (either a native coronary artery or bypassed graft vessel)* with history of previous CABG, and with Class II, III or IV angina that persists despite maximal GDMT or who have a contraindication to, or are intolerant of maximal GDMT; or
  4. Symptomatic individuals with 1 or more intermediate (50% to 69% diameter) coronary artery stenoses with a Fractional Flow Reserve (FFR*) of less than or equal to 0.80, and with Class II, III or IV angina that persists despite maximal GDMT or who have a contraindication to, or are intolerant of maximal GDMT.

Note:
*
For further information about terminology, such as unprotected left main CAD, SYNTAX scoring, STS-predicted scores, GDMT, FFR rating and others, see the Definitions section of this document.

Not Medically Necessary:

Percutaneous coronary interventions are considered not medically necessary when the criteria are not met and for all other applications.                                                                                                                               

Coding

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

CPT

 

92920

Percutaneous transluminal coronary angioplasty; single major coronary artery or branch

92921

Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery

92924

Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch

92925

Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery

92928

Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch

92929

Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery

92933

Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch

92934

Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery

92937

Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel

92938

Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft

92943

Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel

92944

Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft

92978

Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel [only as an adjunct to angioplasty, stent, atherectomy or revascularization procedures listed above]

92979

Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel [only as an adjunct to angioplasty, stent, atherectomy or revascularization procedures listed above]

 

 

HCPCS

 

C9600

Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; a single major coronary artery or branch

C9601

Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery

C9602

Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch

C9603

Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery

C9604

Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel

C9605

Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft

C9607

Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel

C9608

Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft

 

 

ICD-10 Diagnosis

 

 

All diagnoses

Discussion/General Information

The medically necessary criteria within this document are based on a review of the following evidence-based guidelines and other specialty society guidance documents:**** 

Table 1: Grading of Angina Pectoris by the Canadian Cardiovascular Society Classification System:

Class I:

Ordinary physical activity does not cause angina, such as walking, climbing stairs. Angina (occurs) with strenuous, rapid, or prolonged exertion at work or recreation.

Class II:

Slight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals or in cold, or in wind, or under emotional stress, or only during the few hours after awakening. Angina occurs on walking more than 2 blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and in normal condition.

Class III:

Marked limitations of ordinary physical activity. Angina occurs on walking one to two blocks on the level and climbing one flight of stairs in normal conditions and at a normal pace.

Class IV:

Inability to carry on any physical activity without discomfort—anginal symptoms may be present at rest.

Percutaneous coronary intervention (PCI) refers to a minimally invasive revascularization procedure which may include percutaneous transluminal coronary (balloon) angioplasty (PTCA) with or without coronary stent placement and coronary atherectomy. Specific procedure selection is at the discretion of the treating cardiovascular physician/interventionalist. In clinical practice, these PCI procedures are often performed at the time of cardiac catheterization when the occlusive vascular lesion is identified, localized, and can be approached via percutaneous instrumentation. PCI is performed for the treatment of coronary artery disease (CAD) when the individual’s symptoms, medical history and prior noninvasive test results are consistent with moderate to high risk for CAD.

There has been investigation into performance of staged PCI procedures in individuals with multi-vessel CAD who have sustained an ST-segment elevation myocardial infarction (STEMI). The initial (or primary) PCI procedure is done to treat the “Culprit” (or infarct) lesion which was responsible for the individual’s symptoms and angiographic evidence of significant coronary occlusion. Thereafter, a second PCI is performed to treat the “Non-culprit” (or non-infarct) lesion(s) when there is angiographically significant evidence of CAD in other coronary vessels which puts the person at continued risk for adverse cardiac events. Outcomes data are available from comparative cohort studies, randomized controlled trials (RCT), large registry data and meta-analysis, which have demonstrated lower risk of cardiovascular mortality for staged PCI of “Culprit” and “Non-culprit” lesions. Rates of major adverse cardiac events post procedure were reported as superior or similar in subjects who underwent “Culprit only” PCI and in those who had staged PCI performed. A recent meta-analysis of RCTs reported that staged PCI of “Culprit” and “Non-culprit” CAD was associated with a non-significant trend towards reduced cardiovascular mortality, as compared with “Culprit only” PCI (0.54 [0.26 to 1.10]; p=0.09) (Kowalewski, 2015). The authors of multiple studies acknowledge that these findings need further confirmation in larger, adequately powered, randomized clinical trials (Dahal, 2014; El-Hayek, 2015; Ma, 2015; Pandit, 2014; Russo, 2015; Toyota, 2016; Vlaar, 2011; Wald, 2013).  

The 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction made the following recommendations:
Class I:
PCI is indicated in a noninfarct artery at a time separate from primary PCI in patients who have spontaneous symptoms of myocardial ischemia. (Level of Evidence: C);

Class IIa:
PCI is reasonable in a noninfarct artery at a time separate from primary PCI in patients with intermediate- or high-risk findings on noninvasive testing (Level of Evidence: B) (O’Gara, 2013).

The 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction modified its recommendations regarding staged PCI of “Culprit-only” vs. Multivessel PCI from Class III (HARM) to Class IIb and also expanded the timeframe in which multivessel PCI could be performed. This is based on the conflicting trial results and varying study protocols currently available:

Although several observational studies and a network meta-analysis have suggested that multivessel staged PCI may be associated with better outcome than multivessel primary PCI, there are insufficient observational data and no randomized data at this time to inform a recommendation with regard to the optimal timing of nonculprit vessel PCI. Additional trial data that will help further clarify this issue are awaited.

Class IIb:

PCI of a noninfarct artery may be considered in selected patients with STEMI and multivessel disease who are hemodynamically stable, either at the time of primary PCI or as a planned staged procedure (Level of Evidence: B-R*); (Levine, 2015).

*Evidence level B-R: Is defined as coming from randomized trials of moderate quality evidence from 1 or more RCTS and meta-analyses of moderate quality RCTs.

Definitions

Acute coronary syndrome (ACS): This term refers to any group of symptoms attributed to obstruction of the coronary arteries with chest pain being the most common symptom. ACS usually occurs as a result of one of three main etiologies: ST elevation myocardial infarction (30%), non ST-elevation myocardial infarction (25%), or unstable angina (38%).

Angina pectoris (which is also referred to as Definite, Typical or Chronic Stable Angina): This term refers to substernal chest pain or discomfort that is provoked by exertion or emotional stress and relieved by rest and/or nitroglycerin.

Angina pectoris (also referred to as Atypical, Probable or Unstable Angina): Chest pain or discomfort that lacks one of the characteristics of definite or typical angina listed above. This chest pain may occur without prior physical exertion of any kind and may not be relieved by nitroglycerin.

Atherectomy: This term refers to a minimally invasive endovascular technique where atherosclerotic plaque is percutaneously removed from the walls of the coronary vessels.

Cardiac catheterization: A general term describing the use of a thin catheter that is advanced into the bloodstream through an artery at the groin, arm or neck, followed by injection of a contrast agent (dye) that visualizes the coronary arteries and chambers of the heart. Cardiac catheterization, which can be done for diagnostic or therapeutic/interventional purposes or both, can be used to describe imaging of the coronary arteries, (also referred to as coronary angiography), or the heart chambers.

Chest pain (non-anginal): Chest pain or discomfort that meets one or none of the typical angina characteristics.

Congenital heart disease: A general term describing abnormalities in the structure of the heart that are present at birth. The abnormalities can include abnormal heart valves or abnormal communications between the different chambers of the heart.

Congestive heart failure (CHF) or Heart Failure: A condition in which the heart no longer adequately functions as a pump. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the lungs and other organs.

Coronary angiography: A cardiac catheterization procedure (see definition above) that is used to visualize the coronary arteries. 

Coronary angioplasty (also referred to as percutaneous transluminal coronary angioplasty [PTCA]): A therapeutic revascularization procedure that often follows the initial diagnostic imaging procedure. A small balloon is percutaneously placed at the site of the blockage in the coronary artery and then inflated, in order to reopen the artery. Frequently a stent is also placed in the artery to maintain the patency of the vessel for blood flow to the heart. 

Coronary artery bypass grafting (CABG): This invasive surgical procedure involves the revascularization of stenosed coronary vessel segments which are bypassed and replaced with patent segments taken from the veins in the legs (saphenous) or other areas of the body. CABG is typically performed for more complex or advanced CAD where multiple coronary arteries have significant occlusion to blood flow or where the individual’s anatomy precludes a percutaneous approach. When a stenosed segment of a coronary artery is bypassed for the first time, that is considered a “Native or de novo coronary artery;” when a previously bypassed segment needs to be revascularized, by either CABG or PTCA, the stenosed vessel segment is often part of a saphenous vein graft that had been previously used to replace the stenosed segment of a coronary artery but has now restenosed. If a previously placed coronary stent is involved, it is referred to as in-stent restenosis.

Coronary artery disease (CAD): This cardiac disease involves the atherosclerotic build-up of plaque on the inside walls of the coronary arteries which results in partial or complete occlusion or stenosis of the vessel and often leads to myocardial infarction (MI) if untreated.

Fractional Flow Reserve (FFR): A diagnostic measurement which assesses the clinical significance (severity) of coronary artery stenosis associated with CAD. FFR is defined as the ratio of coronary flow (pressure) proximal to the stenotic lesion relative to the coronary pressure distal to the stenotic lesion, under maximal coronary vasodilation (hyperemia). Small ultrasound transducers are used which enable intracoronary Doppler ultrasound to measure the flow velocity across a coronary lesion (See FAME trial; Tornino, 2010). Coronary stenoses with FFR less than or equal to 0.75 or 0.80 are considered significant (Levine, 2011).

Guideline-directed medical therapy (GDMT): For context within this document, this terminology, which was formerly referred to as “Optimal medical therapy,” is defined as the use of at least 2 classes of medication to reduce angina symptoms (for example, beta blockers, calcium channel blockers, nitrate preparations, ranolazine). In the event that an individual is unable to tolerate 2 anti-angina medications, the maximum tolerated level of medical therapy will be considered to be maximal GDMT.

Imaging procedure: This is a general term describing a technique to provide an image of a structure; in this case, a picture of the heart or coronary arteries. Angiography and right and left heart catheterization produce images by injecting dye into the heart chambers or coronary arteries, respectively. Other types of cardiac imaging procedures include echocardiography, CT or MRI scans.

Intracoronary thrombolysis: This therapy involves the use of thrombolytic agents (for example, streptokinase [Streptase, Kabikinase]), to dissolve coronary thrombus which occlude the coronary arteries and are frequently associated with acute MI. The purpose is to restore adequate patency of the coronary vessels.

Left heart: Describes the two chambers on the left side of the heart; the left atrium, which receives oxygenated blood from the lungs, and the left ventricle, which pumps the blood through the circulation.

Left ventricular ejection fraction (LVEF): The measurement of the heart's ability to pump blood through the body. Normal LVEF readings would be in the 58-70% range.

Mechanical thrombectomy: This refers to the physical/mechanical removal or debulking of a thrombus from within a coronary artery. It is sometimes performed percutaneously with specialized instrumentation at the time of PTCA to remove the occlusion and restore adequate blood flow through the coronary vessels.

Myocardial infarction (MI): The medical term for heart attack. A heart attack occurs when the blood supply to part of the heart muscle (the myocardium) is severely reduced or blocked which is seen in advancing CAD.

New York Heart Association (NYHA) definitions:

The NYHA classification of heart failure is a 4-tier system that categorizes subjects based on subjective impression of the degree of functional compromise; the four NYHA functional classes are as follows:

Percutaneous coronary intervention (PCI): A general term describing a therapeutic procedure that is typically done at the same time as cardiac catheterization. The most common PCI is PTCA with or without stent placement to treat CAD when identified in the immediately previous coronary angiography/catheterization. 

Pericardial tamponade: An acute condition where pressure builds up around the heart, impairing cardiac function, due to fluid accumulation in the pericardial sac, which is referred to as pericardial effusion.

Pericarditis (restrictive): Refers to inflammation of the pericardial sac, which is termed restrictive or constrictive when the inflammatory process results in diminished ability of the heart to beat normally. This condition is usually due to an infection but it may also occur following an MI or cardiac surgery.

Pulmonary hypertension: A rare lung condition where increased pressure in the pulmonary artery compromises cardiopulmonary function.

Right heart: Describes the two chambers on the right side of the heart; the right atrium, which receives the blood returning from the rest of the body, and the right ventricle that pumps this blood to the lungs.

Risk Stratification for adverse events from CAD: The following definitions of risk are taken from the ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization focused update (Patel, 2012):

High Risk (> 3% annual mortality rate):

  1. Severe resting left ventricular dysfunction (LVEF < 35%);
  2. High-risk treadmill score (score < -11*);
  3. Severe exercise left ventricular dysfunction (exercise LVEF < 35%);
  4. Stress-induced large perfusion defect (particularly if anterior);
  5. Stress-induced multiple perfusion defects of moderate size;
  6. Large, fixed perfusion defect with LV dilation or increased lung uptake (thallium-201);
  7. Stress-induced moderate perfusion defect with LV dilation or increased lung uptake (thallium-201);
  8. Echocardiographic wall motion abnormality (involving > 2 segments) developing at low dose of dobutamine;
  9. (≤ 10 mg/kg/min) or at a low heart rate (< 120 beats/min);
  10. Stress echocardiographic evidence of extensive ischemia.

Intermediate-risk (1% to 3% annual mortality rate):

  1. Mild/moderate resting left ventricular dysfunction (LVEF 35% to 49%);
  2. Intermediate-risk treadmill score (score between -11 and < 5*);
  3. Stress-induced moderate perfusion defect without LV dilation or increased lung intake (thallium-201);
  4. Limited stress echocardiographic ischemia with a wall motion abnormality only at higher doses of dobutamine involving less than or equal to 2 segments.

(*The Duke Treadmill Score (DTS) is a weighted index combining treadmill exercise time using standard Bruce protocol, maximum net ST segment deviation (depression or elevation), and exercise-induced angina. It was developed to provide accurate diagnostic and prognostic information for the evaluation of individuals with suspected CAD as follows:

>= +5  Low risk
+4 to -10 Moderate risk
<= -11  High risk. (Additional information available at: http://www.csecho.ca/wp-content/themes/twentyeleven-csecho/cardiomath/index.php?eqnHD=stress&eqnDisp=duketsc.)

Stents, Intracoronary: A short, narrow mesh tube made of metal or plastic which is deployed percutaneously at the time of PTCA into the coronary circulation at the location of a stenosed segment or lesion, in order to restore blood flow and facilitate the continued patency and integrity of the recanalized vessel. Some stents have a durable polymer coating which elutes a time released antiproliferative agent, (for example, sirolimus-eluting stent [Cordis Corporation, Johnson & Johnson, Warren, NJ] and Taxus [paclitaxel-eluting stent, Boston Scientific Corporation, Natick, Mass]) which is intended to ensure continued patency and reduce the likelihood of in-stent restenosis. Additional drug-eluting stents with different eluting agents are in early trials investigation.

Structural heart disease: A general term describing abnormalities in the structure of the heart, which includes diseases of the valves or congenital heart disease (present at birth). A cardiac catheterization procedure can evaluate the structure and function of the heart by assessing the left ventricular ejection fraction (see definition above), as well as the movement of the valves of the heart and of the chamber walls. 

STS-predicted score: Refers to the Society of Thoracic Surgeons scoring range taken from the STS National Cardiac database; an STS-predicted score of greater than 2% is considered to predict increased risk for an adverse surgical outcome. Both STS and SYNTAX scores (see below) have been shown to predict adverse outcomes from revascularization procedures (PCI and CABG).

SYNTAX score: Stands for the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery study score. The SYNTAX score is considered a reasonable surrogate for the extent and complexity of CAD and is useful in decision making regarding revascularization options.

Transcatheter intravascular ultrasound (IVUS): This imaging technique involves passage of a miniaturized ultrasound transducer mounted on the tip of a catheter, directly into an artery or vein to produce either 2-dimensional tomographic images or 3-dimensional computer-assisted reconstructions of planar IVUS images. IVUS is used as an adjunct to angioplasty, atherectomy, or stent placement.

Unprotected left main CAD: This term refers to an occlusion (or stenosis) of the left main coronary artery. The left main is considered, “Protected” when collateral blood flow or a patent bypass graft exists which connects either the left anterior descending or circumflex artery to the blood flow through the coronary arterial system.

Vasculopathy: A term that refers to any disorder or disease process affecting the blood vessels.

References

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  31. Wald DS, Morris JK, Wald NJ, et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013; 369(12):1115-1123.
  32. Weintraub WS, Spertus JA, Kolm P, et al. Effect of PCI on quality of life in patients with stable coronary disease. NCT00007657. N Engl J Med. 2008; 359(7):677-687.
  33. Winchester DE, Wen X, Brearley WD, et al. Efficacy and safety of glycoprotein IIb/IIIa inhibitors during elective coronary revascularization: a meta-analysis of randomized trials performed in the era of stents and thienopyridines. J Am Coll Cardiol. 2011; 57(10):1190-1199.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. Anderson JL, Adams CD, Antman EM, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 Guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127(23):e663-e828.
  2. Bashore TM, Balter S, Barac A, et al. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions (ACCF/SCAI) expert consensus document on cardiac catheterization laboratory standards update. J Am Coll Cardiol. 2012; 59(24):2221-2305.
  3. Centers for Disease Control (CDC). Million Hearts: Strategies to reduce the prevalence of leading cardiovascular disease risk factors. United States, 2011. MMWR. 2011; 60(36):1248-1251.
  4. Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation (ISHLT) Guidelines for the care of heart transplant recipients. J Heart/Lung Transpl. 2010; 29(8):914-956.
  5. Desai NR, Bradley SM, Parzynski CS, et al. Appropriate Use Criteria for Coronary Revascularization and Trends in Utilization, Patient Selection, and Appropriateness of Percutaneous Coronary Intervention. JAMA. 2015; 314(19):2045-2053.
  6. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012; 60(24):e44-e164.
  7. Hannan EL, Cozzens K, Samadashvili Z, et al. Appropriateness of coronary revascularization for patients without acute coronary syndromes. J Am Col Cardiol. 2012; 59(21):1870-1876.
  8. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011; 58(24):e44-122.
  9. Levine GN, O’Gara PT, Bates ER, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2015.
  10. Lotfi A, Jeremias A, Fearon WF, et al. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: a consensus statement of the Society of Cardiovascular Angiography and Interventions (SCAI). Cath Cardiovasc Interven. 2013.
  11. National Institutes of Health (NIH). Multiple ongoing trials regarding cardiac catheterization and angioplasty. Available at: http://clinicaltrials.gov/ct2/results?fund=0&fund=1&recr=Open&term=Cardiac+Catheterization. Accessed on May 31, 2018.
  12. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63(22):e57-185.
  13. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127(4):e362-e425. A
  14. Patel MR, Bailey SR, Bonow RO, et al. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, Society of Thoracic Surgeons. J Thorac Cardiovasc Surg. 2012; 144(1):39-71.
  15. Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients with Stable Ischemic Heart Disease: a Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017; 69(17):2212–2241.
  16. Patel MR, Dehmer GJ, Hirshfeld JW, et al. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2012; 59(9):1-25.
  17. Russo JJ, Wells GA, Chong AY, et al. Safety and efficacy of staged percutaneous coronary intervention during index admission for ST-elevation myocardial infarction with multivessel coronary disease (insights from the University of Ottawa Heart Institute STEMI registry). Am J Cardiol. 2015; 116(8):1157-1162.
  18. Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA Guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999; 33(6):1756-1824.
  19. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation. 2008; 118(23):2395-2451.
  20. Wolk MJ, Bailey SR, Doherty JU, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014; 63(4):380-406.
  21. Wright RS, Anderson JL, Adams CD, et al. 2011 ACCF/AHA Focused update of the guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; 123(18):2022-2060.
  22. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guidelines for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 128(16):e240-e327.
Websites for Additional Information
  1. National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH). Cardiac catheterization. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cath/. Accessed on May 31, 2018.
  2. National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH). Percutaneous Coronary Intervention. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty/. Accessed on May 31, 2018.
Index

Angioplasty
Atherectomy, Coronary
Coronary Artery Disease (CAD)
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Percutaneous Coronary Intervention (PCI)
PTCA
Stents, Intracoronary

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

History

Status

Date

Action

Reviewed

07/26/2018

Medical Policy & Technology Assessment Committee (MPTAC) review. Updated References and Websites section.

Reviewed

11/02/2017

MPTAC review. The document header wording updated from “Current Effective Date” to “Publish Date.” Discussion and References sections were updated.

Reviewed

11/03/2016

MPTAC review. The Discussion section and References were updated. Updated Coding section with 01/01/2017 CPT descriptor revisions for codes 92978, 92979.

Revised

08/15/2016

MPTAC review. Updated the formatting in the Clinical Indications section. Made a minor edit to the not medically necessary statement for consistent formatting. The Discussion section and References were updated. Removed ICD-9 codes from Coding section.

New

08/06/2015

MPTAC review. Initial guideline development.