In ischemic heart disease, clogged arteries cause the heart muscle
to be deprived of the oxygen-rich blood needed to function. Patients
with ischemic heart disease may experience chest pain or shortness of
breath during exercise or times of stress.
The American College of Cardiology, along with several partnering
organizations, today released updated appropriate use criteria for
performing coronary revascularization in patients with stable ischemic
‘The updated criteria has been developed to assist clinicians in the rational use of coronary revascularization in stable ischemic heart disease patients.’
This update is the second of a two-part revision for coronary
revascularization. The first part updated appropriate use criteria for
coronary revascularization in patients with acute coronary syndromes and
was published last December. These criteria were developed to assist
clinicians in the rational use of coronary revascularization in common
clinical scenarios found in everyday practice.
"These new appropriate use criteria are an important advance in the
efforts of the partnering societies to improve the quality of
cardiovascular care and deliver the right care to the right patients,"
said Manesh R. Patel, chief of the division of
cardiology and co-director of the Duke Heart Center at Duke University
and chair of the writing committee for the document. "The document
provides a framework for how patients and providers can think about
revascularization in the stable setting and will help health systems and
medical societies judge quality of care."
The writing group was tasked with developing clinical indications or
scenarios that reflect typical situations encountered in everyday
practice; these scenarios were later rated by a technical panel. The
clinical scenarios were scored to indicate whether revascularization is
appropriate, may be appropriate, or is rarely appropriate for the
clinical scenario presented.
For this update, the format of the document has been modified to
address concerns and improvements suggested by physicians and
professional organizations. The rating panel members included an
increased percentage of physicians directly involved in performing
revascularization procedures, such as interventional cardiologists and
Prior recommendations mandating two antianginal drugs, which are
used to treat chest pain, for medical therapy have been replaced by a
step-wise use of antianginals. This starts ideally with a
guideline-directed beta-blocker as first-line therapy, with other
antianginals used to escalate therapy as clinically necessary. This is
integrated with the determination of appropriateness for percutaneous
coronary intervention or coronary artery bypass grafting as medical
therapy is advanced. Writing committee members said they felt this
approach was more applicable to real-world treatment patterns.
The updated criteria now place a greater emphasis on global risk
assessments for future events and non-invasive testing results.
According to the writing committee, the criteria should be used as
an overall guide, and physicians should evaluate each case on an
individual basis. Patients should ask their providers if their proposed
revascularization is appropriate.