Thread by @Dr_i3rahimSaleh

2021 #ACC/AHA/SCAI Guideline for Coronary Artery Revascularization
jacc.org/doi/10.1016/j.…
#ACCFIT #CardioTwitter #medtwitter #ACCIC
10 Take-home messages:

1. Coronary revascularization should be based on clinical indications, regardless of sex, race, or ethnicity.

2. In patients being considered for coronary revascularization for whom the optimal treatment strategy is unclear, a multidisciplinary Heart Team approach is recommended.

3. For significant LM disease, CABG is indicated to improve survival relative to that likely to be achieved with medical therapy. PCI is a reasonable compared with medical therapy, in low to medium complex CAD and LM disease that is equally suitable for CABG or PCI

4.Updated evidence with regard to mortality benefit of revascularization in SIHD, normal LV EF , and 3VD. CABG may be reasonable to improve survival. A survival benefit with PCI is uncertain. Revasc. decisions based on complexity, technical feasibility, and Heart Team discussion.

5.Use of radial artery as a surgical revascularization conduit is preferred versus a saphenous vein conduit to bypass the second most important target vessel after the LAD. Benefits include superior patency, reduced adverse cardiac events, and improved survival.

6.Radial artery access is recommended in ACS, SIHD patients undergoing PCI to reduce bleeding and vascular complications compared with a femoral approach. Patients with acute coronary syndrome also benefit from a reduction in mortality rate with this approach.

7.A short duration of DAPT after PCI in patients with SIHD is reasonable to reduce bleeding risk. After consideration of recurrent ischemia and bleeding risks, select patients may safely transition to P2Y12 inhibitor monotherapy and stop aspirin after 1 to 3 months of DAPT

8.Staged PCI of a nonculprit artery in STEMI is recommended. Nonculprit PCI at the time of 1st PCI may be considered in stable pts w uncomplicated revasc. of the culprit, low complex nonculprit, and normal renal function. PCI of the nonculprit can be harmful in cardiogenic shock

9.Revascularization decisions in patients with DM and multivessel CAD are optimized by the use of a Heart Team approach. Patients with diabetes who have triple vessel disease should undergo surgical revascularization; PCI may be considered if they are poor candidates for surgery.

10.Treatment decisions for pts undergoing CABG should include the calculation of STS score surgical risk. SYNTAX score calculation in treatment decisions is less clear because of the interobserver variability in its calculation and its absence of clinical variables.