The misinterpretation of appropriate use criteria for. Adjudicating coronary revascularization 7 1 2015 the 2009 appropriate use criteria auc for coronary revascularization were designed to optimize care given deficient practice guidelines. The appropriate use criteria auc for coronary revascularization were developed to critically examine and improve patient selection for pci as well as address concerns about potential overuse. Appropriate use criteria for coronary revascularization in patients with. Omission of heart transplant recipients from the appropriate. The first part updated appropriate use criteria for coronary revascularization in patients with acute coronary syndromes and was published last december. Introduction in a continuing effort to provide information to patients, physicians, and policy makers, the appropriate use task force approved this revision of the. Edited by susan sadoughi, md, and andre sofair, md, mph. Appropriate use criteria for coronary revascularization and trends. These assessments are based on the appropriate use criteria for coronary revascularization focused update developed by the acc, society for cardiovascular. A report of the american college of cardiology appropriate use criteria task force, american association for thoracic surgery, american heart association, american society of echocardiography, american society of nuclear cardiology. The document is part one of a twopart revision for coronary revascularisation. Concordance of the heart team to appropriate use criteria had a 99. The methodology used to develop the appropriate use criteria for coronary revascularization has been described see the box for additional details.
Among patients who underwent percutaneous revascularization, 34. Scaiqit appropriate use criteria app for diagnostic catheterization and coronary revascularization. Revascularization heart team recommendations as an adjunct to. A persistent concern regarding the appropriate use criteria for coronary revascularization is the validity of the criteria themselves, given that ratings for many clinical scenarios were based on expert opinion in the context of available evidence. Update focuses on coronary revascularization in patients with acute coronary syndromes. Appropriate use criteria for icdcrt online appendix guideline mapping and references document section 1. Cardiogenic shock due to suspected acs pci, stemi, uanstemi update 2011 proposed draft 5. Download scais quality improvement toolkit scaiqit appropriate use criteria auc app for diagnostic catheterization and coronary revascularization to join the interventional and invasive cardiology community in tackling continuous quality improvement cqi in the cardiac cath lab and. Mar 10, 2017 the following are key points to remember about the 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease sihd. The cathpci registry outcomes report contains updated metrics that can be used to identify and categorize patients undergoing a pci into one of the appropriate use criteria auc categories. New appropriate use criteria for coronary revascularization released 21 december 2016 the american college of cardiology, along with several partnering organizations, today released. Appropriate use of revascularization varies in stable. Importance guidelines endorse routine coronary angiography and percutaneous coronary intervention pci to screen for and treat cardiac allograft vasculopathy in heart transplant recipients. New appropriate use criteria for coronary revascularisation.
Coronary revascularization in patients with stable ischemic heart disease. Understanding the reporting of appropriate use criteria in. The revascularization appropriate use criteria auc are based on the current understanding of procedure outcomes plus the potential patient benefits and risks of the revascularization strategies examined. Updated appropriate use criteria address coronary revascularization for patients with sihd 10 march 2017 the american college of cardiology, along with several partnering organizations, today released. Previous studies have demonstrated that up to 1 in 6 pcis performed for nonacute indications were inappropriate, with substantial variation in.
Routine testing after percutaneous coronary intervention pci please refer to the specific section of the measure specification to identify the denominator and numerator information for use in submitting this individual specification. Appropriate use criteria for cardiac catheterization and coronary revascularization article pdf available in chinese medical journal 1276. Appropriate use criteria and complex coronary interventions. These criteria were developed to assist clinicians in the rational use of coronary revascularization in common clinical scenarios found in everyday practice. A report of the american college of cardiology foundation appropriateness criteria task force. However, the current appropriate use criteria for revascularization aucr do not recognize prior heart transplant as a unique pci indication. The american college of cardiology, the american heart association, and other groups have published new appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease. Dec 24, 2016 the document is part one of a twopart revision for coronary revascularisation. Oct 12, 2012 a persistent concern regarding the appropriate use criteria for coronary revascularization is the validity of the criteria themselves, given that ratings for many clinical scenarios were based on expert opinion in the context of available evidence. Scai has again collaborated with the american college of cardiology, the american heart association, the society of thoracic surgery and other organizations to develop appropriate use criteria auc for coronary artery revascularization. In a new table, revascularization before renal transplantation or structural heart procedures tavr, mitraclip, etc. Appropriate use criteria for diagnostic catheterization guideline mapping document section 1. Participantsappendix b relationships with industry and other entitiespatel et al. Appropriate use criteria for revascularization wikidoc.
Appropriate use criteria for coronary revascularization in. The authors address acs in this document with updated reassessments of clinical scenarios. Choice of revascularization strategy and appropriate use criteria. Appropriate use criteria jacc pdf key points to remember. Revascularization heart team recommendations as an adjunct. A report of the american college of cardiology appropriate use criteria task force. Accfscaistsaatsahaasnc 2009 appropriateness criteria for. Vf or hemodynamically unstable vt associated with acute appropriate use criteria for coronary revascularization part ii july 05, 2017. Aims clinical appropriateness guidelines hereinafter aims clinical. With respect to the method of coronary revascularization for patients with advanced or complex atherosclerosis, the writing group presented various clinical scenarios and independently judged pci or cabg as a revascularization method figure 2. In previous auc documents, indications for revascularization for acute coronary.
Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the midrange 4 to 6 indicate that coronary revascu larization may be appropriate for the clinical scenario. The following are key points to remember about the 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease sihd. Coronary revascularization in patients with acute coronary syndromes. Dec 21, 2016 after much speculation and nearly a years worth of rumors about their impending release, updated appropriate use criteria auc for coronary revascularization are finally entering the public domain. The proportion of nonacute pcis classified as inappropriate has declined, although hospitallevel variation in inappropriate pci persists.
Appropriate use criteria for radionuclide imaging all. Nonstelevation acute coronary syndromes jacc pdf hub. Guidelines and clinical documents american college of cardiology. Symptomatic patients with prior postrevascularization pci or cabg or in asymptomatic patients when revascularization was incomplete and additional revascularization is feasible. Updated appropriate use criteria address coronary revascularization for patients with sihd 10 march 2017 the american college of cardiology, along. Accfscaistsaatsahaasnc 2009 appropriateness criteria. This study supports the validity of the criteria for stable coronary disease, he said.
This takes into consideration the available scientific evidences, the health care environment, the patients profile and a physicians judgment. Chair, coronary revascularization writing group immediate past chair appropriate use criteria task force michael j. The role of appropriate use criteria for coronary revascularization. Cardiac stress imaging not meeting appropriate use criteria. Appropriate use criteria for icdcrt online appendix. Views of appropriate use criteria for catheterization and percutaneous coronary revascularization by practicing interventional cardiologists. Download scais quality improvement toolkit scaiqit appropriate use criteria auc app for diagnostic catheterization and coronary revascularization to join the interventional and invasive cardiology community in tackling continuous quality improvement. Immediate past chair, appropriate use criteria task force michael j. Appropriate use criteria for radionuclide imaging all for one. Pdf appropriate use criteria for cardiac catheterization. The new 2017 appropriate use criteria for coronary revascularization part i june 23, 2017. Appropriate use criteria for revascularization in stable. Appropriate use criteria for diagnostic catheterization.
Wolk, md, macc, moderator appropriate use criteria task force 1. Article in catheterization and cardiovascular interventions 733. The new 2017 appropriate use criteria for coronary revascularization part ii july 05, 2017. The goal of the appropriate use criteria is to provide general guidance to both patients and clinicians regarding when and how often revascularization procedures should be done. The new 2017 appropriate use criteria for coronary. Concordance of physician ratings with the appropriate use. The ultimate objective of the auc is to improve patient care and health outcomes in a costeffective manner. Both are special situations where coronary revascularization may be warranted before the procedure, but patients often do not have symptoms or lack the noninvasive testing needed to demonstrate myocardial ischemia.
The appropriate use criteria auc for coronary revascularization in patients with stable ischemic heart disease sihd were first published in 2009 11 and then updated in 2012 22. Appropriate use criteria for coronary revascularization. A report of the american college of cardiology appropriate use criteria task. Results of a survey of american college of cardiology interventional section members.
Use of appropriate use criteria is increasing, but what. The american college of cardiology, society for cardiovascular angiography and interventions, society of thoracic surgeons, and american association for thoracic surgery, along with key specialty and subspecialty societies, have completed a 2part revision of the appropriate use criteria auc for coronary revascularization. Appropriate use criteria auc for advanced diagnostic imaging educational and operations. Apr 21, 2015 to validate the 2012 appropriate use criteria for diagnostic catheterization by examining the relationship between the appropriateness of cardiac catheterization in patients with suspected stable ihd and the proportion of patients with obstructive coronary artery disease cad and subsequent revascularization. To validate the 2012 appropriate use criteria for diagnostic catheterization by examining the relationship between the appropriateness of cardiac catheterization in patients with suspected stable ihd and the proportion of patients with obstructive coronary artery disease cad and subsequent revascularization. New appropriate use criteria for coronary revascularization. The appropriate use criteria auc provide recommendations for performing the right test on the right patient at the right time. Views of appropriate use criteria for catheterization and. The first appropriate use criteria auc for coronary revascularization were published in 2009 with an update published in 2012. This analysis of data from the ncdr cathpci registry reports that hospital volumes of nonacute percutaneous coronary intervention pci, and proportions of pci classified as inappropriate, have decreased since publication of the appropriate use criteria for coronary revascularization. Guidelines and clinical documents american college of. Appropriate use of revascularization varies in stable cad. Use of appropriate use criteria is increasing, but what are. In prior coronary revascularization auc documents, indications for revascu larization in acute coronary syndromes acs and stable ischemic.
Complete revascularization, physiologic assessment, and shared decisionmaking are all addressed in the new document that refreshes the 2012 version. In rating these criteria, the rating panel was asked to assess whether the use of revascularization for each indication is appropriate care, may be appropriate care, or is rarely appropriate care using the following definitions and their associated numeric ranges. Wolk, md, macc, moderator, appropriate use criteria task force introduction in a continuing effort to provide information to patients, physicians, and policy makers, the appropriate use task force approved this revision of the 2012 coronary revascularization auc. Obstructive cad on ccta or invasive coronary angiography. Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention. With this feature, ncdr hospitals will be better informed and able to track their use of pci. Clinical practice guidelines in patients with cardiovascular disease and comorbid. Appropriate use criteria for coronary revascularization and. Coronary angiography with or without left heart catheterization and left ventriculography table 1. Evaluation of revascularization before other procedures. Scctsts 2017 appropriate use criteria for coronary revascularization in. The updated appropriate use criteria for coronary revascularisation in patients with stable ischemic heart disease are forthcoming.
This is a twopart revision of the appropriate use criteria for coronary revascularization and was divided into two documents addressing acs and stable ischemic heart disease. However, due to the constituency of its technical panel and limitations in methodology, the noble intent of the auc. In prior coronary revascularization auc documents, indications for revascularization in acute coronary syndromes and stable ischemic heart. Appropriate use criteria for cardiac catheterization and coronary revascularization.
Percutaneous transluminal revascularization of or through coronary. Appropriate use criteria for coronary revascularization in patients. Jun 23, 2017 the new 2017 appropriate use criteria for coronary revascularization part i june 23, 2017. Validation of the appropriate use criteria for coronary. Conclusions and relevance since the publication of the appropriate use criteria for coronary revascularization in 2009, there have been significant reductions in the volume of nonacute pci.