2012-01-31 美国心脏病学会基金会 J Am Coll Cardiol. 2012 Feb 28;59(9):857-81. Epub 2012 Jan 30.




2012ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT Appropriate Use Criteria for Coronary Revascularization Focused Update




The American College of Cardiology Foundation (ACCF),Society for Cardiovascular Angiography and Interventions,Society of Thoracic Surgeons, and the American Associa-tion for Thoracic Surgery, along with key specialty andsubspecialty societies, conducted an update of the appropri-ate use criteria (AUC) for coronary revascularization fre-quently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Thisupdate provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The method-ology used in this update is similar to the initial document,and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9.Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients’ health outcomes or survival. Scores of 1 to 3 indicate revascularization isconsidered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain.In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. Theprimary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research.





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