Guideline on diagnosing, managing ischemic heart disease updated

A guideline on diagnosis and management of stable ischemic heart disease was updated last week by a collaboration of cardiology organizations.


A guideline on diagnosis and management of stable ischemic heart disease was updated last week by a collaboration of cardiology organizations.

The new update of the 2012 guideline, which was led by an American College of Cardiology/American Heart Association task force, added recommendations about the role of coronary angiography to diagnose coronary artery disease (CAD) in patients with suspected stable ischemic heart disease (SIHD), particularly those who are candidates for revascularization or in whom the results of angiography are likely to result in important changes to therapy.

The update also changed recommendations on chelation therapy, from not recommending chelation (based on Level C evidence) to stating that the usefulness of chelation in reducing cardiovascular events is uncertain (based on Level B evidence). The guideline writers reviewed the current evidence on chelation for the update and concluded that the therapy's usefulness was “highly questionable.”

The update also included a review of recommendations regarding enhanced external counterpulsation (EECP), in response to comments received after publication of the 2012 guideline. After re-examining the literature, the update writers made no changes to the existing recommendation that EECP may be considered for the relief of refractory angina in patients with SIHD.

Finally, the update changed some recommendations on revascularization. A heart team approach is now recommended for patients with diabetes and complex multivessel CAD. A recommendation about use of coronary artery bypass grafting (CABG) in preference to percutaneous coronary intervention was revised and strengthened to specify that CABG is generally preferred in patients with diabetes and multivessel CAD if revascularization is likely to improve survival and the patient is a good candidate for surgery.

In addition to the ACC and AHA, the guideline was issued by the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions and Society of Thoracic Surgeons. It was published July 28 by the Journal of the American College of Cardiology, and Circulation. ±html