2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Abstract

Aim: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. Methods: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

“…In conclusion, in most PCI settings, these intracoronary techniques, OCT or IVUS, might improve procedural success and prevent late stent failure avoiding suboptimal device deployment. However, current guidelines strongly suggest their use, preferentially OCT, to investigate the mechanisms of stent failure [ 2 , 58 ]; increasing awareness and understanding of NA mechanisms, they might potentially guide appropriate invasive treatments. Table 3 reports the most important studies investigating the usefulness of IVUS and OCT in the NA setting [ 14 , 42 , 47 , 54 , 55 , 56 , 59 , 60 , 61 , 62 , 63 , 64 ].…”

The Gut Microbiome, Seleno-Compounds, and Acute Myocardial Infarction

“…All of the participants were provided a hospital diet and had not used any antibiotics for the preceding 3 months, the goal being to minimize any potential confounding effects on the microbiota. All of the AMI patients were diagnosed with ST-elevation MI, had accepted percutaneous coronary intervention, and were following medical treatment at the intensive care unit after coronary intervention according to the guideline of the American College of Cardiology [ 11 ]. No complications such as cardiogenic shock, hypotension, pulmonary congestion, and renal or respiratory failure were noted during hospitalization.…”

Fundamentals of percutaneous coronary bifurcation interventions

“…In both stable CAD and ACS interventions, high ST risk patients such as bifurcation PCI ≥ 2 stents and LMCA PCI, the duration of DAPT may be prolonged beyond 12 mo if the bleeding risk is not high (Class IIb indication for stable CAD and class IIa indication for ACS)[ 41 , 154 ]. However, in the case of high bleeding risk ( e.g., PRECISE-DAPT score ≥ 25), DAPT duration may be considered as 3 mo for stable CAD and 3-6 mo for ACS patients with the cessation of P2Y 12 inhibitor (Class IIa indication according to ESC and Class IIb indication according to the latest AHA/ACC guidelines, for both stable CAD and ACS)[ 41 , 154 - 156 ]. Finally, after the recent publication of 5 large trials that also included CBLs, the AHA/ACC recommends a class Ⅱa indication for a shorter DAPT duration (1-3 months) followed by P2Y 12 inhibitor monotherapy to reduce the risk of bleeding events in selected patients [ 156 ].…”