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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More from @CianPMcCarthy

9 Dec
Session IV of #BacktoHeart21 covering all things cardiometabolic disease occuring now!

First up, @JJheart_doc discusses SGLTI2 for T2DM and ASCVD!

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Next up @busediabetes discusses GLP-1 agonists in patients with T2DM and ASVCD!
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Session 3 of #BacktoHeart21 happening now and covering #Lipids moderated by @FaRodriguezMD @PamelaBMorris & @DLBHATTMD!

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@FaRodriguezMD @PamelaBMorris @DLBHATTMD @alanbrownmd @MedscapeLIVE Next up @PamelaBMorris discusses lipid lowering beyond statins!

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@FaRodriguezMD @PamelaBMorris @DLBHATTMD @alanbrownmd @MedscapeLIVE @DrRSRosenson provides a expert review of HIV and ischemic heart disease!

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28 Oct
⚡️💥BREAKING 💥⚡️
The 2021 ACC/AHA/CHEST/SAEM/SCCT/SCMR Chest Pain guideline was published online today!

Link to paper:
jacc.org/doi/10.1016/j.…

Here are my personal takeaways!
👇

Thread /
2/ First, huge congratulations to the chair @DrMarthaGulati, vice-chairs Drs. Levy and Mukherjee and the writing committee including @DLBHATTMD, @RonBlankstein @RBP0612 @labunne @ErikHessMD @docHj @lesleejshaw. Incredible work! Not an easy task to put this together..
3/ Let’s start with acute chest pain in the ED. The committee advise against using the term atypical chest pain; instead favoring categorizing as cardiac, possibly cardiac, and non-cardiac chest pain. I like this concept a lot!
Read 15 tweets
29 Aug 20
My 15 highlights 💡from the 2020 ESC NSTE-ACS guideline:

1. Hs troponins recommeded over conventional assays 🧪
2. ESC 0'1 and 0'2 algorithms preferred over 0'3
3. TTE recommended for all patients.
4. If rule-out using ED algorithm but still have concern for ACS, a non-invasive modality is preferred to invasive coronary angio
5. Pre-treatment with P2Y12 not recommended prior to invasive coronary angiogram
6. Prasugrel preferred over ticagrelor if undergoing PCI 💊
7. Both preferred over clopidogrel unless not available
8. UFH preferred to LMWH for NSTEMI 💉
Read 6 tweets

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