New Revascularization Guidelines Released by ACC, AHA, and SCAI

Jennifer Lawton, MD

The American College of Cardiology (ACC), American Heart Association (AHA), and Society for Cardiovascular Angiography and Interventions (SCAI) have partnered to release new joint guideline recommendations for coronary artery revascularization they hope will replace or retire half a dozen older guidelines related to PCI or CABG.

Composed by a 24-person writing committee that included representatives from the American Association for Thoracic Surgery and Society of Thoracic Surgeons, the new set of recommendations is aimed at providing a comprehensive evidence-based overview of coronary artery revascularization and calls for equitable treatment for women and adults from diverse racial or ethnic groups.

“Coronary artery disease remains a leading cause of morbidity and mortality globally, and coronary revascularization is an important therapeutic option when managing patients with this disease,” said Jennifer S. Lawton, MD, guideline writing committee chair and professor of surgery at Johns Hopkins Medicine, in a statement from the AHA. “Treatment recommendations in the guideline outline an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients’ interests.”

A 97-page document citing more than 1100 references, the guideline recommendations are broken down into 17 subsections addressing topics such as intervention, surgery, and medical therapy in certain populations, including appropriate use of surgical revascularization or percutaneous revascularization for different disease states. Recommendations highlighted by the ACC and AHA include a shorter 1-3 month DAPT period after PCI in select patients to reduce bleeding risk and a pivot to recommending radial access over femoral access when a clinician experienced in radial access is available and PCI is the most appropriate treatment.

Atop the 17 subsections within the article was a portion dedicated to the top take-home messages from the recommendations. View the slideshow below for more on the top 10 take-home messages.

The evidence used to compose the guidelines was compiled through a comprehensive literature search performed from May-September 2019 that encompassed studies, reviews, and other evidence related to human subjects from multiple databases, including PubMed, Embase, and others. Authors noted additional relevant studies published through May 2021 were also considered in the writing process.

“The Heart Team has become an important paradigm in clinical practice, emphasizing the importance of team consensus on the optimal approach to revascularization,” said Jacqueline E. Tamis-Holland, MD, guideline writing committee vice-chair and professor of medicine at the Icahn School of Medicine at Mount Sinai.

These guidelines, “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization” were published simultaneously in the Journal of the American College of Cardiology and Circulation.