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Journal of Nuclear Cardiology

, Volume 24, Issue 2, pp 439–463 | Cite as

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes

A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons
  • Manesh R. Patel
  • John H. Calhoon
  • Gregory J. Dehmer
  • James Aaron Grantham
  • Thomas M. Maddox
  • David J. Maron
  • Peter K. Smith
APPROPRIATE USE CRITERIA

Abstract

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. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes (ACS) and stable ischemic heart disease were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and in an effort to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing ACS and stable ischemic heart disease individually. This document presents the AUC for ACS.

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. This update provides a reassessment of clinical scenarios that the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.

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.

As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with ST-segment elevation myocardial infarction and non–ST-segment elevation myocardial infarction were considered appropriate. Likewise, clinical scenarios with unstable angina and intermediate- or high-risk features were deemed appropriate. Additionally, the management of nonculprit artery disease and the timing of revascularization are now also rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

Keywords

ACC Appropriate Use Criteria coronary revascularization imaging medical therapy multimodality 

Supplementary material

12350_2017_780_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 42 kb)

References

  1. 1.
    Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2012;59:857-81.CrossRefPubMedGoogle Scholar
  2. 2.
    O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78-140.CrossRefPubMedGoogle Scholar
  3. 3.
    Jneid H, Anderson JL, Wright RS, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012;60:645-81.CrossRefPubMedGoogle Scholar
  4. 4.
    Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64:1929-49.CrossRefPubMedGoogle Scholar
  5. 5.
    Levine GN, O’Gara PT, Bates ER, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2016;67:1235-50.CrossRefPubMedGoogle Scholar
  6. 6.
    Engstrom T, Kelbaek H, Helqvist S, et al. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3-PRIMULTI): an open-label, randomised controlled trial. Lancet. 2015;386:665-71.CrossRefPubMedGoogle Scholar
  7. 7.
    Gershlick AH, Khan JN, Kelly DJ, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015;65:963-72.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Wald DS, Morris JK, Wald NJ, et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013;369:1115-23.CrossRefPubMedGoogle Scholar
  9. 9.
    Bradley SM, Spertus JA, Kennedy KF, et al. Patient selection for diagnostic coronary angiography and hospital-level percutaneous coronary intervention appropriateness: insights from the National Cardiovascular Data Registry. JAMA Intern Med. 2014;174:1630-9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chan PS, Patel MR, Klein LW, et al. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306:53-61.PubMedGoogle Scholar
  11. 11.
    Desai NR, Bradley SM, Parzynski CS, et al. Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention. JAMA. 2015;314:2045-53.CrossRefPubMedGoogle Scholar
  12. 12.
    Hendel RC, Patel MR, Allen JM, et al. Appropriate use of cardiovascular technology: 2013 ACCF appropriate use criteria methodology update. J Am Coll Cardiol. 2013;61:1305-17.CrossRefPubMedGoogle Scholar
  13. 13.
    Smith SC Jr, Allen J, Blair SN, et al. 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 Institute. J Am Coll Cardiol. 2006;47:2130-9.CrossRefPubMedGoogle Scholar
  14. 14.
    Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation. 2002;106:388-91.CrossRefPubMedGoogle Scholar
  15. 15.
    Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2007;115:114-26.CrossRefPubMedGoogle Scholar
  16. 16.
    Adult Treatment Panel III. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421.Google Scholar
  17. 17.
    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206-52.CrossRefPubMedGoogle Scholar
  18. 18.
    Harold JG, Bass TA, Bashore TM, et al. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Revise the 2007 Clinical Competence Statement on Cardiac Interventional Procedures). J Am Coll Cardiol. 2013;62:357-96.CrossRefPubMedGoogle Scholar
  19. 19.
    Hillis LD, Smith P, Anderson J, et al. 2011 ACCF/AHA guidelines for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011;58:e123-210.CrossRefPubMedGoogle Scholar
  20. 20.
    Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44-122.CrossRefPubMedGoogle Scholar
  21. 21.
    Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139-228.CrossRefPubMedGoogle Scholar
  22. 22.
    TIMI Study Group. http://www.timi.org. Accessed March 15, 2011.
  23. 23.
    Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. Patient Educ Couns. 2012;86:9-18.CrossRefPubMedGoogle Scholar
  24. 24.
    Lin GA, Fagerlin A. Shared decision making: state of the science. Circ Cardiovasc Qual Outcomes. 2014;7:328-34.CrossRefPubMedGoogle Scholar
  25. 25.
    Ting HH, Brito JP, Montori VM. Shared decision making: science and action. Circ Cardiovasc Qual Outcomes. 2014;7:323-7.CrossRefPubMedGoogle Scholar
  26. 26.
    Buchanan A. Medical paternalism. Philos Public Aff. 1978;7:370-90.PubMedGoogle Scholar

Copyright information

© American College of Cardiology Foundation 2017

Authors and Affiliations

  • Manesh R. Patel
    • 1
  • John H. Calhoon
    • 2
  • Gregory J. Dehmer
    • 3
    • 4
  • James Aaron Grantham
    • 5
    • 6
  • Thomas M. Maddox
    • 7
    • 8
  • David J. Maron
    • 9
  • Peter K. Smith
    • 10
  1. 1.Duke University Health System, Duke Clinical Research InstituteDurhamUSA
  2. 2.Department of Cardiothoracic Surgery, Heart and Vascular InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  3. 3.Baylor Scott & White - Temple MemorialTempleUSA
  4. 4.Health Science CenterTexas A&M UniversityBryanUSA
  5. 5.Saint Luke’s HospitalKansas CityUSA
  6. 6.Kansas City School of MedicineUniversity of MissouriKansas CityUSA
  7. 7.VA Eastern Colorado Health Care SystemDenverUSA
  8. 8.University of ColoradoAuroraUSA
  9. 9.Stanford University School of MedicineStanfordUSA
  10. 10.Division of Cardiovascular and Thoracic SurgeryDuke UniversityDurhamUSA

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