Cardiology Organizations Release New Guidelines for Coronary Revascularization Treatment

The American College of Cardiology Foundation has recently released revised guidelines for coronary artery bypass graft surgery and percutaneous coronary intervention, according to ACC news releases.

ACCF and the American Heart Association rewrote a set of guidelines for the management of patients undergoing CABG based on a formal review of studies published in the past decade. The guidelines address the use of CABG and PCI for coronary revascularization. This coronary artery disease revascularization section, which was developed jointly by the PCI and CABG writing committees, is also included in revisions to the PCI guideline. 

The 2011 CABG guideline says PCI is a reasonable alternative to CABG in stable patients with left main coronary artery disease who have a low risk of PCI complications and an increased risk of adverse surgical outcomes. The guideline also states CABG is superior to medical therapy and PCI for most patients with three-vessel disease. Other issues the revised guideline addresses include bypass graft conduit, off-pump CABG vs. on-pump CABG and preoperative and postoperative antiplatelet therapy.

The second revised guideline for PCI was written by ACCF, AHA and the Society for Cardiovascular Angiography and Interventions. The guideline includes a Class I recommendation for using a "heart team" approach when choosing a treatment for patients with unprotected left main or complex CAD. In this approach, interventional cardiologists and cardiothoracic surgeons jointly review the patient's condition, evaluate the risks and benefits of each treatment option and present this information to the patient with their recommendation.

The 2011 PCI guideline addresses other topics, including statin therapy, vascular closure devices and PCI in hospitals without on-site surgical back-up.

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