Don’t order or refer for percutaneous coronary intervention in patients with stable coronary artery disease that do not have high risk features, and are asymptomatic or have not been on optimal medical therapy.

Performing percutaneous coronary intervention in the absence of a clear indication is costly and exposes patients to procedural risks, radiation, contrast exposure, and possible stent-related complications. Patients whose symptoms are controlled on optimal medical therapy, and who do not have any high-risk findings* on non-invasive testing (e.g., exercise treadmill test, myocardial perfusion imaging, stress echocardiography, or coronary computed tomographic angiography), should not be referred for percutaneous coronary intervention.

*This table outlines high-risk features of non-invasive test results associated with >3% annual rate of death or MI.

Sources:

Mancini GB, et al. Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease. Can J Cardiol. 2014 Aug;30(8):837–849. PMID: 25064578.

Boden WE, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 Apr 12;356(15):1503-16. PMID: 17387127.

Al-Lamee R et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018 Jan 6;391(10115):31–40. PMID: 29103656.