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Canadian Journal of Cardiology

Missing the Goal With the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization∗

Published:March 24, 2022DOI:https://doi.org/10.1016/j.cjca.2022.03.013
      On December 9, 2021, the updated American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) Guideline for Coronary Artery Revascularization was released.
      • Lawton J.S.
      • Tamis-Holland J.E.
      • Bangalore S.
      • et al.
      2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
      A notable surprise was a downgrade in the class of recommendation for the use of coronary artery bypass grafting (CABG) in patients with stable ischemic heart disease (SIHD), normal left ventricular ejection fraction (LVEF), and significant stenoses in 3 major epicardial coronary arteries. In general, classes of recommendations range from Class 1 to Class 3, with Class 1 indicating a procedure or intervention that is effective for most patients and should be used, and 2b suggesting that benefit only marginally exceeds risk.
      • Arnett D.K.
      • Claas S.A.
      Tracing and assessing the evolution of clinical guidelines.
      In the new guideline, the previous Class 1 recommendation from the 2011 CABG Guideline
      • Hillis L.D.
      • Smith P.K.
      • Anderson J.L.
      • et al.
      2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
      for the use of CABG to improve survival in patients with SIHD was lowered to a Class 2b recommendation.
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