2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…This practice seems unchanged despite knowledge about adverse outcome in this population. The current ACC/AHA guidelines for patients with stable CAD echoes the ACC/AHA recommendations for patients with unstable angina/non–ST‐segment–elevation MI for subgroups of patients with no obstructive CAD, which was defined as CSX 22, 78. While there have been studies evaluating therapy in patients with CSX,79, 80, 81, 82 these studies are limited in their characterization of coronary vasomotor function.…”

Transatlantic editorial: A comparison between European and North American guidelines on myocardial revascularization

“…Primary criteria for urgency (invasive strategy within 24 h) are met with rising troponin levels, dynamic ST-segment or T-wave changes or a GRACE score of >140 [1]. In the American guidelines [2][3][4], the recommendation for these urgent patients is based on a more general rule, indicating that the acuity of presentation and extent of ischaemia dictate the timing of intervention. Interestingly, both guidelines see only the need for revascularization strengthened.…”

“…As a general comment, the European guidelines are more procedurally directive than the American guidelines. The 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update [4] does not contain any new guidelines with respect to radial artery (RA) grafting. The STS has recently published Clinical Practice Guidelines on Arterial Conduits that do address the RA [5].…”

“…Although the ACC, AHA and associated societies have performed a recent focused update for the diagnosis and management of patients with stable ischaemic heart disease [4], this did not address the issues of off-pump and on-pump CABG, and optimal conduit selection. Therefore, the comparisons and comments on these topics are solely based on the 2011 ACCF/AHA Guidelines for CABG Surgery [2] and the 2014 ESC/EACTS Guidelines on MR [1].…”

“…Since these early times, MR techniques have gained clinical importance worldwide and are now one of the most commonly performed interventions in modern medicine. On the other side of the Atlantic, the American societies have also published several guidelines on MR: in 2011, the ACCF/AHA Guidelines for CABG Surgery [2]; the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischaemic heart disease [3]; the 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update [4] and in 2015, the Society of Thoracic Surgeons (STS) Clinical Practice Guidelines on Arterial Conduits [5].…”