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Lawton et al 2021 ACC/AHA/SCAI Coronary Revascularization Guideline

CLINICAL STATEMENTS AND GUIDELINES

January 18, 2022 Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038

1.2 Organization of the Writing Committee

The writing committee consisted of clinicians, general cardiologists, interventional cardiologists, cardiac surgeons, a cardiac anesthesiologist, an advanced nurse practitioner, and 2 lay/patient representatives. The writing committee included representatives from the ACC, AHA, Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery, and Society of Thoracic Surgeons (STS). Appendix 1 of the present document lists writing committee members’ relevant RWI. For the purposes of full transparency, the writing committee members’ comprehensive disclosure information is available in a Supplemental Appendix.

1.3 Document Review and Approval

This document was reviewed by 2 official reviewers each nominated by the ACC and AHA; 1 reviewer each from the ACC, AHA, STS, American Association for Thoracic Surgery, and SCAI; and 31 individual content reviewers. Reviewers’ RWI information was distributed to the writing committee and is published in Appendix 2. The present document was approved for publication by the governing bodies of the ACC, AHA, and SCAI.

1.4 Scope of the Guideline

The scope of the “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization” is to provide an update to and to consolidate the 2011 coronary artery bypass graft (CABG) surgery1 and the 2011 and 2015 percutaneous coronary intervention (PCI) guidelines,2,3 with the added consideration of using a patient-centric disease approach. The applicable sections on revascularization from the 2012 stable ischemic heart disease (SIHD) guideline,4 as well as the 2013 ST-segment–elevation myocardial infarction (STEMI)5 and 2014 non–ST-segment–elevation myocardial infarction (NSTEMI) guidelines,6 will also be updated. This present guideline will affect the following documents:

1.	 Replace/retire the 2011 PCI guideline.2 2.	 Replace/retire the 2011 CABG guideline.1 3.	 Replace/retire the 2015 update in PCI in STEMI guideline.3 4.	 Replace/retire the 2013 STEMI guideline, Sections 4.1, 4.2, 4.3, 4.4, 5.3 (deals with transfer after lytic with intent to do PCI), 6.2, 6.4, 7.1, and 7.2.5 5.	 Replace/retire 2014 non–ST-segment–elevation acute coronary syndrome (NSTE-ACS) guideline, Sections 4.4.4, 5.1.1, 5.1.2.1, 5.1.2.2, 5.1.2.3, and 5.2.6 6.	 Replace/retire the 2012 SIHD guideline, Section 5.4

The intended primary target audience consists of cardiovascular clinicians who are involved in the care of patients for whom revascularization is considered or indicated. Coronary artery disease (CAD) is to be approached with the most current treatment options and treated as a “condition.” Recommendations are stated in reference to the patients and their condition. The focus is to provide the most up-to-date evidence to inform the clinician during shared decision-making with the patient. Although the document is not intended to be a procedural-based manual of recommendations that outlines the best practice for coronary revascularization, there are certain techniques that surgeons or interventional cardiologists might use that are associated with improved clinical outcomes. In developing the 2021 coronary artery revascularization guideline, the writing committee reviewed previously published guidelines and related statements. Table 1 contains a list of these

2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation ACC/AHA 201822 Spontaneous Coronary Artery Dissection: Current State of the Science AHA 201823 Contemporary Management of Cardiogenic Shock AHA 201724 Secondary Prevention After Coronary Artery Bypass Graft Surgery: A Scientific Statement From the American Heart

Association AHA 201525 Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2018 ADA 201826 AACVPR indicates American Association of Cardiovascular and Pulmonary Rehabilitation; AAPA, American Association of Physician Assistants; AATS, American Association for Thoracic Surgery; ABC, Association of Black Cardiologists; ACC, American College of Cardiology; ACCF, American College of Cardiology Foundation; ACP, American College of Physicians; ACPM, American College of Preventive Medicine; ADA, American Diabetes Association; AGS, American Geriatrics Society; AHA, American Heart Association; APhA, American Public Health Association; ASE, American Society of Echocardiography; ASH, American Society of Hypertension; ASNC, American Society of Nuclear Cardiology; ASPC, American Society for Preventive Cardiology; HFSA, Heart Failure Society of America; HRS, Heart Rhythm Society; NLA, National Lipid Association; NMA, National Medical Association; PCNA, Preventive Cardiovascular Nurses Association; SCAI, Society for Cardiovascular Angiography and Interventions; SCCT, Society of Cardiovascular Computed Tomography; SCMR, Society for Cardiovascular Magnetic Resonance; and STS, Society of Thoracic Surgeons.

Table 1.  Continued

Title Organization Publication Year (Reference)

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