ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization

a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology.

Manesh R. Patel, Gregory J. Dehmer, John W. Hirshfeld, Peter K. Smith, John A. Spertus, Frederick A. Masoudi, Ralph G. Brindis, Karen J. Beckman, Charles E. Chambers, T. Bruce Ferguson, Mario J. Garcia, Frederick L. Grover, David R. Holmes, Lloyd W. Klein, Marian Limacher, Michael J. Mack, David J. Malenka, Myung H. Park, Michael Ragosta, James L. Ritchie & 9 others Geoffrey A. Rose, Alan B. Rosenberg, Richard J. Shemin, William S. Weintraub, Michael J. Wolk, Joseph M. Allen, Pamela S. Douglas, Robert C. Hendel, Eric D. Peterson

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
JournalCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Volume73
Issue number3
StatePublished - Feb 15 2009
Externally publishedYes

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Advisory Committees
Cardiology
Percutaneous Coronary Intervention
Coronary Artery Bypass
Survival
Health
Regional Health Planning
Transplants
Patient Education
Acute Coronary Syndrome
Anatomy
Decision Making
Ischemia
Physicians
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization : a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology. / Patel, Manesh R.; Dehmer, Gregory J.; Hirshfeld, John W.; Smith, Peter K.; Spertus, John A.; Masoudi, Frederick A.; Brindis, Ralph G.; Beckman, Karen J.; Chambers, Charles E.; Ferguson, T. Bruce; Garcia, Mario J.; Grover, Frederick L.; Holmes, David R.; Klein, Lloyd W.; Limacher, Marian; Mack, Michael J.; Malenka, David J.; Park, Myung H.; Ragosta, Michael; Ritchie, James L.; Rose, Geoffrey A.; Rosenberg, Alan B.; Shemin, Richard J.; Weintraub, William S.; Wolk, Michael J.; Allen, Joseph M.; Douglas, Pamela S.; Hendel, Robert C.; Peterson, Eric D.

In: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Vol. 73, No. 3, 15.02.2009.

Research output: Contribution to journalArticle

Patel, MR, Dehmer, GJ, Hirshfeld, JW, Smith, PK, Spertus, JA, Masoudi, FA, Brindis, RG, Beckman, KJ, Chambers, CE, Ferguson, TB, Garcia, MJ, Grover, FL, Holmes, DR, Klein, LW, Limacher, M, Mack, MJ, Malenka, DJ, Park, MH, Ragosta, M, Ritchie, JL, Rose, GA, Rosenberg, AB, Shemin, RJ, Weintraub, WS, Wolk, MJ, Allen, JM, Douglas, PS, Hendel, RC & Peterson, ED 2009, 'ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology.', Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, vol. 73, no. 3.
Patel, Manesh R. ; Dehmer, Gregory J. ; Hirshfeld, John W. ; Smith, Peter K. ; Spertus, John A. ; Masoudi, Frederick A. ; Brindis, Ralph G. ; Beckman, Karen J. ; Chambers, Charles E. ; Ferguson, T. Bruce ; Garcia, Mario J. ; Grover, Frederick L. ; Holmes, David R. ; Klein, Lloyd W. ; Limacher, Marian ; Mack, Michael J. ; Malenka, David J. ; Park, Myung H. ; Ragosta, Michael ; Ritchie, James L. ; Rose, Geoffrey A. ; Rosenberg, Alan B. ; Shemin, Richard J. ; Weintraub, William S. ; Wolk, Michael J. ; Allen, Joseph M. ; Douglas, Pamela S. ; Hendel, Robert C. ; Peterson, Eric D. / ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization : a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology. In: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2009 ; Vol. 73, No. 3.
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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.",
author = "Patel, {Manesh R.} and Dehmer, {Gregory J.} and Hirshfeld, {John W.} and Smith, {Peter K.} and Spertus, {John A.} and Masoudi, {Frederick A.} and Brindis, {Ralph G.} and Beckman, {Karen J.} and Chambers, {Charles E.} and Ferguson, {T. Bruce} and Garcia, {Mario J.} and Grover, {Frederick L.} and Holmes, {David R.} and Klein, {Lloyd W.} and Marian Limacher and Mack, {Michael J.} and Malenka, {David J.} and Park, {Myung H.} and Michael Ragosta and Ritchie, {James L.} and Rose, {Geoffrey A.} and Rosenberg, {Alan B.} and Shemin, {Richard J.} and Weintraub, {William S.} and Wolk, {Michael J.} and Allen, {Joseph M.} and Douglas, {Pamela S.} and Hendel, {Robert C.} and Peterson, {Eric D.}",
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AU - Patel, Manesh R.

AU - Dehmer, Gregory J.

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AU - Spertus, John A.

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AU - Garcia, Mario J.

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AU - Shemin, Richard J.

AU - Weintraub, William S.

AU - Wolk, Michael J.

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AU - Douglas, Pamela S.

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AU - Peterson, Eric D.

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