2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization now published!
Here are my top takeaways!
Thread/
Link:
jacc.org/doi/10.1016/j.…
2/ For stable CAD and left main stenosis, CABG is recommended (Class 1). PCI is a reasonable option if low-medium anatomic complexity and if equally suitable to PCI compared to CABG (Class IIa)
3/ In general, revascularization is recommended (Class 1) for stable ischemic heart disease for 1) refractory angina despite medical therapy, 2) left main disease, 3) ischemic cardioyopathy and suitable for CABG. See this figure for details
3/ Radial artery is recommended in preference to saphaneous vein graft for 2nd conduit for CABG.
Radial access recommended over femoral access for PCI for ACS and stable CAD
4/ For stable CAD undergoing PCI, DAPT for 6 months recommended. Shorter (1-3 months) or longer courses are reasonable in select patients.
For ACS undergoing PCI, 12 months of DAPT recommended but shorter or longer courses possible also
5/ For hemodynamically stable STEMI patients with multivessel disease, staged PCI of non-infarct vessel recommended (Class 1). Elective CABG is reasonable after primary PCI also (Class IIa).
Multivessel PCI at the time of primary PCI not recommended for STEMI with shock
6/ For patients with diabetes and multivessel disease including LAD, revascularization with CABG preferred to PCI
7/ Congratulations to all the authors led by Chair Dr. Jennifer Lawton and vice-Chair @HollandTamis! @SripalBangalore @SVRaoMD @Drroxmehran @GarimaVSharmaMD
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