ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization
ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization
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DOI：
10.1002/ccd.21964
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发表时间：
2009-02-15
影响因子：
2.3
通讯作者：
Spertus, John A.
中科院分区：
文献类型：
--
作者：
Patel, Manesh R.;Dehmer, Gregory J.;Spertus, John A.
美国心脏病学会基金会(ACCF)、心血管血管造影术和干预学会、胸科外科医生学会和美国胸科外科学会，以及主要专科和专科学会，对经常考虑冠状动脉血运重建的常见临床情景进行了适宜性评估。临床方案是为了模拟日常实践中遇到的常见情况而开发的，包括有关症状状态、药物治疗范围、通过非侵入性测试评估的风险水平以及冠状动脉解剖的信息。一个撰写委员会制定了大约180个临床方案，并由一个单独的技术小组进行评分，从1到9分。7到9分表明血运重建被认为是合适的，可能会改善健康结果或存活率。从1分到3分，表明血运重建被认为是不合适的，不太可能改善健康结果或生存。中间范围(4到6)表明临床情况下，冠状动脉血运重建将改善健康结果或存活率的可能性被认为是不确定的。对于大多数临床方案，专家小组只考虑血运重建的适宜性，而不考虑这是通过经皮冠状动脉介入治疗(PCI)还是冠状动脉搭桥术(CABG)完成的。在一组临床方案中，血运重建通常被认为是合适的，考虑了单独使用经皮冠状动脉介入治疗和冠状动脉旁路移植术作为血运重建的主要模式的适宜性。总的来说，冠状动脉血运重建在急性冠脉综合征和合并显著症状和/或缺血的患者中的使用是有利的。相比之下，无症状患者或无创检测和最低限度药物治疗的低风险患者的血运重建则不那么受欢迎。预计这些结果将对医生的决策和关于血运重建的预期益处的患者教育产生影响，并将有助于指导未来的研究。
The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered.In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is anticipated that these results will have an impact on physician decision making and patient education regarding expected benefits from revascularization and will help guide future research.