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ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/ STS 2016 Appropriate use criteria for coronary revascularization in patients with acute coronary syndromes

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

This document presents the appropriate use criteria for coronary revascularization in acute coronary syndromes. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, presence of clinical instability or ongoing ischemic symptoms, prior reperfusion therapy, risk level as assessed by noninvasive testing, fractional flow reserve testing, and coronary anatomy.

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 (4 to 6) indicate that coronary revascularization may be appropriate for the clinical scenario. Seventeen clinical scenarios were developed by a writing committee and scored by the rating panel: 10 were identified as appropriate, 6 as may be appropriate, and 1 as rarely appropriate.

Key words: appropriate use criteria, coronary artery bypass graft, coronary revascularization, percutaneous coronary intervention, acute coronary syndromes.