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Lawton et al 2021 ACC/AHA/SCAI Coronary Revascularization Guideline CLINICAL STATEMENTS AND GUIDELINES Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038 January 18, 2022 African Americans, but there was no interaction between race and the mortality benefit of revascularization.9 Similar results have been reported for women with shock in the CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock trial.57 In the TACTICS-TIMI 18 (Treat Angina With Aggrastat and Determine Cost of Therapy With Invasive or Conservative Strategy—Thrombolysis In Myocardial Infarction 18) trial, evaluating patients with NSTE-ACS, non-White patients and female patients had more comorbidity and more major adverse cardiovascular event (MACE) outcomes than White and male patients but were revascularized at the same rate. After adjustment for baseline characteristics, the invasive strategy was equally beneficial for all patients, without evidence of racial differences.10 A meta-analysis of RCT of invasive vs conservative strategies in women and men with NSTE-ACS reported a similar proportional benefit of an invasive strategy in women and men, (although low risk women with biomarker negative ACS did not derive a benefit to an early invasive strategy).1 Additionally, studies have shown similar relative benefits of primary PCI3 and revascularization in SIHD.5,6 for women and men. In view of these findings, the decision to offer revascularization should be made on the basis of a patient’s clinical characteristics, and preferences and should be the same for all patients, regardless of sex, race, or ethnicity. 2.2 Shared Decision-Making and Informed Consent Recommendations for Shared Decision-Making and Informed Consent COR LOE Recommendations 1 C-LD 1. In patients undergoing revascularization, decisions should be patient centered—that is, considerate of the patient’s preferences and goals, cultural beliefs, health literacy, and social determinants of health—and made in collaboration with the patient’s support system.1,2 1 C-LD 2. In patients undergoing coronary angiography or revascularization, adequate information about benefits, risks, therapeutic consequences, and potential alternatives in the performance of percutaneous and surgical myocardial revascularization should be given, when feasible, with sufficient time for informed decision-making to improve clinical outcomes.3-5 Synopsis Shared decision-making (Figure 1) is a collaborative approach that provides patients with unbiased, evidence-based information on treatment choices and encourages a dialogue between patients and providers, with the aim of making decisions that use scientific evidence and align with the patient’s values and preferences.3,4,6 It is essential that the clinician use terminology that the patient understands to allow effective processing of health information and to foster the patient’s Figure 1. Shared Decision-Making Algorithm. Downloaded from http://ahajournals.org by on October 7, 2026