Are the current American College of Cardiology/American Heart Association stable ischemic heart disease guidelines too conservative?

Abstract

The American College of Cardiology/American Heart Association stable ischemic heart disease (SIHD) practice guidelines, published in 2012, represent a tremendous collaborative effort to synthesize the existing literature and evidence base for patients with SIHD. Notably, the guidelines focus not only upon the appropriate identification of patients with SIHD, but also upon the comprehensive treatment of SIHD patients. In doing so, these guidelines have no doubt already helped numerous practicing physicians who have referenced them; however, the goal of guideline documents is not for the included recommendations to be static, but instead to dynamically adapt over time. In this editorial, we discuss three potential areas of improvement in the guidelines, ranging from the use of specific diagnostic testing and risk-stratification modalities to the preferred treatment approach for symptomatic patients with SIHD.

Keywords::

• angina
• angiography
• coronary disease

Financial & competing interests disclosure

AJ Kirtane has declared institutional research grants to Columbia University from Medtronic CardioVascular, Boston Scientific, Abiomed, St. Jude Medical, Abbott Vascular, Vascular Dynamics and Eli Lilly. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

CHD: Coronary heart disease; GDMT: Guideline-directed medical therapy; SIHD: Stable ischemic heart disease.