The new guidelines update and incorporate the six previous guidelines, and call for fair treatment of women who need open arterial surgery and people from different races or ethnic groups
According to a new joint study, people undergoing open heart arterial surgery (called coronary revascularization) will experience similar results regardless of gender or race, so women and adults from different races or ethnicities should not be restricted from using invasion Sexual heart surgery. Guidelines developed by the American College of Cardiology and the American Heart Association in collaboration with the Society for Cardiovascular Angiography and Intervention. Recommendations for treatment decisions for coronary artery disease revascularization should be based on clinical indications and involve a multidisciplinary cardiac team that includes patients and patient preferences.
Coronary revascularization refers to a procedure used to restore blood flow through a blocked heart artery. It can be performed using percutaneous coronary intervention (PCI), where a stent is placed in a blocked artery through a catheter inserted into the wrist or thigh, or through coronary artery bypass grafting (CABG), where a stent is placed from another part of the artery or Veins are inserted into the body through open heart surgery to bypass the blockage.
"Coronary artery disease is still the main cause of global morbidity and mortality, and coronary revascularization is an important treatment option for managing patients with this disease," said Jennifer S. Lawton, MD, chairman of the guideline writing committee and professor of surgery. "The treatment recommendations in the guidelines outline an evidence-based approach to managing patients with coronary artery disease who are considering coronary revascularization, aimed at improving the quality of care and in the interests of patients."
The guidelines stipulate that in order to ensure fairness and reduce differences in care, all revascularization treatment decisions should be based on clinical indications, regardless of gender, race or ethnicity. There is no evidence that some patients with the same clinical indications benefit less than others; however, there is evidence that non-white patients are less likely to receive reperfusion therapy or invasive strategies such as stent implantation or revascularization.
Evaluate multiple factors to determine which procedure is best for a particular patient, including the location and severity of the obstruction, the patient’s clinical state and symptoms, the patient’s age, type 2 diabetes or a weakened heart, the number of blood vessels affected, and each procedure The risks involved.
According to guidelines, determining the method of revascularization and which treatment strategy is the best method is not always clear to every patient, even when looking at clinical indications. In these cases, a multidisciplinary cardiac team approach is recommended, including cardiologists, cardiac surgeons, and other experts. In addition to the heart team, the patient’s preferences, goals, support system, and understanding of their condition and potential outcomes should also be considered.
"The heart team has become an important example in clinical practice, emphasizing the importance of the team reaching a consensus on the best revascularization method," said Jacqueline E. Tamis-Holland, MD, Vice Chairman of the Guideline Writing Committee and Icahn Professor of Medicine Mount Sinai School of Medicine.
The guidelines update recommendations for intervention, surgery and/or drug treatment for certain populations, including the appropriate use of surgical revascularization or percutaneous revascularization for different disease states. There is evidence that surgery is a reasonable recommendation to improve survival, but for patients with stable ischemic heart disease, normal left ventricular ejection fraction, and three-vessel coronary artery disease, the benefits may not be as great as previously thought drug therapy. . Evidence also shows that in this population, PCI's ability to improve survival compared with drug therapy is uncertain.
When PCI is the most appropriate treatment method, if a clinician with experienced radial access is available, radial access (via the arm artery) and femoral access (via the leg artery, which is the traditional access) will also be recommended. For people who cannot accept radial artery catheterization due to anatomical limitations or the available clinicians have no experience in performing radial access PCI, the femoral access is still the default choice.
Based on the latest evidence, the guidelines also recommend that in certain patients, it is reasonable to shorten the duration of dual antiplatelet therapy (DAPT) by 1-3 months after PCI to reduce the risk of bleeding. The previous recommendation was for DAPT of 6 months or 12 months.
The revascularization guidelines supplement the recently released 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR chest pain assessment and diagnosis guidelines, because revascularization is usually a treatment option for the diagnosis of chest pain. This is part of the ACC and AHA's strategic efforts to deal with the guidelines from a practical perspective, not just subject-based guidelines. This guideline updates and integrates the ACC/AHA 2011 CABG surgical guidelines and the ACC/AHA/SCAI 2011 and 2015 PCI guidelines based on new evidence to provide patient-centered disease treatment. Several recommendations in the guidelines for stable ischemic heart disease (2012), ST-segment elevation myocardial infarction (2013), and non-ST-segment elevation acute coronary syndrome (2014) have also been updated.
"2021 ACC/AHA/SCAI Coronary Artery Revascularization Guidelines" will be published in the Journal of the American College of Cardiology and Circulation at the same time.
About the American College of Cardiology The American College of Cardiology envisions a world of innovation and knowledge to optimize cardiovascular care and outcomes. As the professional home of the entire cardiovascular care team, the mission of the college and its 54,000 members is to transform cardiovascular care and improve heart health. ACC awards certificates to highly qualified cardiovascular professionals and is a leader in the development of health policies, standards and guidelines. The college also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC journal, operates national registrations to measure and improve care, and provides cardiovascular certification for hospitals and institutions. For more information, please visit acc.org.
About the American Heart Association The American Heart Association is the unremitting force that promotes a longer and healthier life in the world. We are committed to ensuring fair health in all communities. Through cooperation with many organizations and supported by millions of volunteers, we fund innovative research, advocate public health, and share life-saving resources. For nearly a century, this Dallas-based organization has been a major source of health information. Contact us via heart.org, Facebook, Twitter or call 1-800-AHA-USA1.
Journal of the American College of Cardiology
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Copyright © 2021 American Association for the Advancement of Science (AAAS)
Copyright © 2021 American Association for the Advancement of Science (AAAS)