title: Staging of multivessel percutaneous coronary interventions: an expert consensus statement from the Society for Cardiovascular Angiography and Interventions.
abstract: Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania 17822, USA. jblankenship@geisinger.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
authors.forename: Issam D
authors.initials: ID
authors.lastname: Moussa
authors.forename: Charles C
authors.initials: CC
authors.lastname: Chambers
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Haldis
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Morrison
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dehmer
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D006328:Cardiac Catheterization / Q000592:standards; D017023:Coronary Angiography / Q000592:standards; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents / Q000592:standards; D016896:Treatment Outcome