ACCF/AHA/SCAI expert consensus document requirements for primary PCI

Avoid intervention in patients with:

>50 percent diameter stenosis of left main artery proximal to infarct-related lesion, especially if the area in jeopardy is relatively small and overall LV function is not severely impaired
Long, calcified, or severely angulated target lesions at high risk for PCI failure with TIMI flow grade 3 present during initial diagnostic angiography
Lesions in other than the infarct artery (unless they appeared to be flow limiting in patients with hemodynamic instability or ongoing symptoms)
Lesions with TIMI flow grade 3 that are not amenable to stenting in patients with left main or three-vessel disease that will require coronary bypass surgery
Culprit lesions in more distal branches jeopardizing only a modest amount of myocardium when there is more proximal disease that could be worsened by attempted intervention

Transfer emergently for coronary bypass surgery patients with:

High-grade left main or three-vessel coronary disease with clinical or hemodynamic instability after successful or unsuccessful PCI of an occluded vessel and preferably with IABP support
Failed or unstable PCI result and ongoing ischemia, with IABP support during transfer

IABP: intra-aortic balloon pump; LV: left ventricular; PCI: percutaneous coronary intervention; SCAI: Society for Cardiovascular Angiography and Interventions; TIMI: Thrombolysis In Myocardial Infarction.

From: 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:e44. Table used with the permission of Elsevier Inc. All rights reserved.

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ACCF/AHA/SCAI expert consensus document requirements for primary PCI