Analysis of the Updated ACC/AHA Coronary Revascularization Guidelines With Implications for Cardiovascular Anesthesiologists and Intensivists

PHYSICIANS DEDICATED TO the care of patients with cardiovascular disease face a daunting task, given the constant evolution of data and guidelines. The American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) released an updated clinical practice guideline for coronary artery revascularization (CAR) in December 2021 to provide a foundation for decision-making in the care of patients in need. 1 Lawton JS Tamis-Holland JE Writing Committee Members2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022; 79: e21-129 Crossref PubMed Scopus (312) Google Scholar This current guideline is nearly all-encompassing on the topics of CAR and related items; per decree of the guideline writing group, the updated guidelines are intended to replace a myriad of several now-outdated guidelines, including the ACC/AHA 2011 guidelines on percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG), among others. 1 Lawton JS Tamis-Holland JE Writing Committee Members2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022; 79: e21-129 Crossref PubMed Scopus (312) Google Scholar The breadth of the 2021 CAR guidelines is considerable; this manuscript offers a focused review of the major updated guideline components targeted toward cardiothoracic anesthesiologists and intensivists, aiming to provide a summary of the items that are of particular importance to perioperative patient care. These guidelines, it should be noted, are not without controversy; not all stakeholders in CAR have endorsed the guidelines. A concise comment on the objections raised by cardiac surgeons also is included.