News of cardiology and cardiac surgery

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/ STS 2017 Appropriate Use Criteria for coronary revascularization in patients with stable ischemic heart disease

Coronary Revascularization Writing Group: M. Patel (Chair), J. Calhoon, G. Dehmer, J. Grantham, T. Maddox, D. Maron, P. Smith

The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. The new AUC for coronary revascularization were developed as separate documents for stable ischemic heart disease (SIHD) and acute coronary syndromes. This document presents the AUC for SIHD. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that coronary revascularization may be appropriate for the clinical scenario. As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with high symptom burden, high-risk features, and high coronary disease burden, as well as in patients receiving antianginal therapy, are deemed appropriate.

Key words: appropriate use criteria, coronary artery bypass grafting, coronary revascularization, percutaneous coronary intervention, stable ischemic heart disease.