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ACC/AHA: Base Coronary Revascularization on Clinical Indications

Treatment decisions for patients with coronary artery disease should be based on clinical indications, regardless of sex, race, ethnicity

FRIDAY, Dec. 10, 2021 (HealthDay News) — Treatment decisions relating to coronary revascularization for patients with coronary artery disease should be based on clinical indications, because no evidence suggests that specific patients benefit more than others, according to joint guidelines issued by the American College of Cardiology and the American Heart Association, in partnership with the Society for Cardiovascular Angiography and Interventions, and published online Dec. 9 in the Journal of the American College of Cardiology.

Jennifer S. Lawton, M.D., from Johns Hopkins Medicine in Baltimore, and colleagues conducted a comprehensive literature search and evidence review to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization.

The authors note that for patients with coronary artery disease, treatment decisions relating to coronary revascularization should be based on clinical indications, regardless of sex, race, or ethnicity; no evidence suggests less benefit for specific patients. A multidisciplinary Heart Team approach is recommended for patients being considered for coronary revascularization for whom the optimal treatment strategy is unclear. Treatment decisions should be patient-centered and should include patient preferences and goals. Surgical revascularization is indicated to improve survival relative to that expected with medical therapy for patients with significant left main disease. For patients with stable ischemic heart disease, normal left ventricular ejection fraction, and triple-vessel coronary artery disease, updated evidence from contemporary trials supplements older evidence relating to the mortality benefit of revascularization. For improving survival, surgical revascularization may be reasonable.

“The Heart Team has become an important paradigm in clinical practice, emphasizing the importance of team consensus on the optimal approach to revascularization,” a coauthor said in a statement.

Several authors and reviewers disclosed financial ties to the pharmaceutical and medical device industries.

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