Indication for percutaneous coronary angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) or balloon angioplasty, was performed in the United States, but the technique remained challenged by the primary problem of ''re-stenosis'', which was approximately 30% closing of the coronary artery after balloon dilatation. When first PTCA introduced by Gruentzig in 1977, it was specific directed for patients who have angina, documented ischemia, single vessel disease, and proximal lesion (simple lesion). But then by the recent advanced in technology including guide wire, balloon, intravascular ultrasound, pharmacological therapy particularly of stents, it is than indicated in much more complex lesions. The extension of indication of PCI to more complex lesion were supported by many studies and clinical trials. Comprehensively indication of PCI were summarize in the two most well known guideline, following first to European Society of Cardiology (ESC, 2005) and second to the American Heart Association (AHA, 2007), American college of cardiology (ACC), and American Society of Cardiac Intervention (ASCAI). The latest guidelines for appropriateness criteria for coronary Revascularization was just published in Jan 2009 by The American College of Cardiology, Society for Cardiovascular Angiography and Intervention and Society of Thoracic surgery. In this guidelines indication of coronary revascularization is assessed following 3 categories which is appropriate, uncertain and inappropriate. Basically those guidelines are the same, there are differ in applying classification of recommendation and level of evidence, the systematic presentation, and the defining appropriateness indication of revascularization.