ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

The American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions (SCAI), The Society of Thoracic Surgeons (STS), and the American Association for Thoracic Surgery (AATS), along with key specialty and subspecialty societies, have published a revision of the appropriate use criteria (AUC) for coronary revascularization in patients with stable ischemic heart disease (SIHD). The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status, risk level as assessed by noninvasive testing, coronary disease burden, and in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria.

A separate independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the middle range of 4 to 6 indicate that coronary revascularization may be appropriate for the clinical scenario.

As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with high symptom burden, high-risk features, and high coronary disease burden, as well as in patients receiving antianginal therapy are deemed appropriate. Additionally, scenarios assessing the appropriateness of revascularization before kidney transplantation or transcatheter valve therapy are now rated.