ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization
- 10 March 2009
- journal article
- practice guideline
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 119 (9), 1330-1352
- https://doi.org/10.1161/circulationaha.108.191768
Abstract
The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is anticipated that these results will have an impact on physician decision making and patient education regarding expected benefits from revascularization and will help guide future research.Keywords
This publication has 14 references indexed in Scilit:
- ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial InfarctionJournal of the American College of Cardiology, 2007
- Primary Prevention of Cardiovascular Diseases in People With Diabetes MellitusCirculation, 2007
- AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update: Endorsed by the National Heart, Lung, and Blood InstituteJournal of the American College of Cardiology, 2006
- ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention—Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)Journal of the American College of Cardiology, 2006
- ACCF Proposed Method for Evaluating the Appropriateness of Cardiovascular ImagingJournal of the American College of Cardiology, 2005
- ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)Journal of the American College of Cardiology, 2004
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 UpdateCirculation, 2002
- Task force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor managementJournal of the American College of Cardiology, 1996
- A clinically relevant classification of chest discomfortJournal of the American College of Cardiology, 1983