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 update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios 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, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 857-881 |
| Number of pages | 25 |
| Journal | Journal of the American College of Cardiology |
| Volume | 59 |
| Issue number | 9 |
| DOIs | |
| State | Published - Feb 28 2012 |
| Externally published | Yes |
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Keywords
- ACCF Appropriate Use Criteria
- coronary artery bypass graft surgery
- percutaneous coronary interventions
- revascularization
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
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 Tomography. / Patel, Manesh R.; Dehmer, Gregory J.; Hirshfeld, John W.; Smith, Peter K.; Spertus, John A.; Masoudi, Frederick A.; Chamber, Charles E.; Ferguson, T. Bruce; Garcia, Mario J.; Grover, Frederick L.; Holmes, David R.; Klein, Lloyd W.; Limacher, Marian C.; MacK, Michael J.; Malenka, David J.; Park, Myung H.; Ragosta, Michael; Ritchie, James L.; Rose, Geoffrey A.; Rosenberg, Alan B.; Russo, Andrea M.; Shemin, Richard J.; Weintraub, William S.; Wolk, Michael J.; Bailey, Steven R.; Douglas, Pamela S.; Hendel, Robert C.; Kramer, Christopher M.; Min, James K.; Shaw, Leslee; Stainback, Raymond F.; Allen, Joseph M.
In: Journal of the American College of Cardiology, Vol. 59, No. 9, 28.02.2012, p. 857-881.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update
T2 - 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 Tomography
AU - Patel, Manesh R.
AU - Dehmer, Gregory J.
AU - Hirshfeld, John W.
AU - Smith, Peter K.
AU - Spertus, John A.
AU - Masoudi, Frederick A.
AU - Chamber, Charles E.
AU - Ferguson, T. Bruce
AU - Garcia, Mario J.
AU - Grover, Frederick L.
AU - Holmes, David R.
AU - Klein, Lloyd W.
AU - Limacher, Marian C.
AU - MacK, Michael J.
AU - Malenka, David J.
AU - Park, Myung H.
AU - Ragosta, Michael
AU - Ritchie, James L.
AU - Rose, Geoffrey A.
AU - Rosenberg, Alan B.
AU - Russo, Andrea M.
AU - Shemin, Richard J.
AU - Weintraub, William S.
AU - Wolk, Michael J.
AU - Bailey, Steven R.
AU - Douglas, Pamela S.
AU - Hendel, Robert C.
AU - Kramer, Christopher M.
AU - Min, James K.
AU - Shaw, Leslee
AU - Stainback, Raymond F.
AU - Allen, Joseph M.
PY - 2012/2/28
Y1 - 2012/2/28
N2 - 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 update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios 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, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research.
AB - 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 update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios 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, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research.
KW - ACCF Appropriate Use Criteria
KW - coronary artery bypass graft surgery
KW - percutaneous coronary interventions
KW - revascularization
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U2 - 10.1016/j.jacc.2011.12.001
DO - 10.1016/j.jacc.2011.12.001
M3 - Article
VL - 59
SP - 857
EP - 881
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 9
ER -