Appropriate Use Criteria for Revascularization in Stable Ischemic Heart Disease Published

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

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. The group recently released similar criteria for patients with acute coronary syndromes.

In the Journal of the American College of Cardiology, the groups describe when revascularization is considered appropriate in various clinical scenarios. They stratify patients based on number of diseased vessels, number of medications, and findings on noninvasive testing.

The authors emphasize that the criteria should not be used to determine payment.

A stepwise approach for anti-anginals replaces previous recommendations that required two antianginal medications. Beta-blockers are now the preferred first-line therapy, and therapy can be escalated with other antianginals (e.g., calcium channel blockers, long-acting nitrates, ranolazine) as needed.