According to ACCF guidelines, when is use of pulmonary artery catheterization (PAC) inappropriate?

Updated: Dec 22, 2017
  • Author: Bojan Paunovic, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

According to the 2012 guidelines from the ACCF, pulmonary artery catheterization is inappropriate in the following settings [2] :

  • When CAD is suspected in an asymptomatic patient with low or intermediate global risk for CAD, in the absence of noninvasive stress imaging showing stenosis of 50% or greater; when CAD is suspected in a symptomatic patient with low pretest probability

  • As adjunctive testing in patients undergoing diagnostic coronary angiography, pulmonary artery catheterization is inappropriate in patients who have nonobstructive disease (non–left main) with stenosis of less than 50% in whom there are unexpected angiographic findings or findings of ischemia, or in the absence of noninvasive testing

  • In cases of arrhythmia, pulmonary artery catheterization is inappropriate in patients at low risk for syncope, in patients at low or intermediate risk for new-onset atrial fibrillation or flutter, and in patients with heart block or symptomatic bradyarrhythmia

  • In preoperative coronary evaluation, pulmonary artery catheterization is inappropriate for patients undergoing low-risk surgery, in patients with 4 or more METS (metabolic equivalents of functional capacity), in patients with no risk factors who are to undergo intermediate-risk surgery or vascular surgery, and in patients with 1 or 2 risk factors who are to undergo intermediate-risk surgery

  • Pulmonary artery catheterization is inappropriate in patients with mild or moderate mitral stenosis, mild or moderate mitral regurgitation, mild or moderate aortic stenosis, or mild or moderate aortic regurgitation

  • In patients with chronic native or prosthetic valvular disease who have symptoms related to their valvular disease, pulmonary artery catheterization is inappropriate for the following, provided that the patient's symptoms are concordant with the clinical impression of severity: mild, moderate, or severe mitral stenosis; mild, moderate, or severe mitral regurgitation; mild, moderate, or severe aortic stenosis; and mild or moderate aortic regurgitation


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