Guidelines for Managing Interventions for Heart Attacks

After a severe heart attack, patients are usually offered a coronary revascularization procedure - a choice between percutaneous coronary intervention (PCI, commonly known as coronary angioplasty or simply angioplasty), or coronary artery bypass (CABG).  The former is done by an “interventional cardiologist” in a “cath-lab” environment, while bypass surgery is clearly a surgical procedure.  There’s been some argumentation among specialists as which approach is superior.  Now the American Heart Association, the American College of Cardiology Foundation, and the Society for Cardiovascular Angiography and Interventions have updated guidelines that are available online in the Journal of the American College of Cardiology.

The guidelines themselves are clearly so specialized that it would be pointless for me to try to summarize them here.  What’s important, however, is that they were a collaboration between surgeons and interventionalists, mirroring a "heart-team" approach to coronary revascularization decisions that’s recommended in the guidelines.  A consensus was established between cardiologists and surgeons over patient selection for the two main procedures, PCI or CABG.  Most of the recommendations are based on data from randomized clinical trials where there was consensus between a cardiac surgeon and a cardiologist that the patient could be equally well-treated by PCI or CABG.

One of the strongest recommendations in the guidelines is that the decision about a revascularization procedure should be made by a heart team, including a surgeon and an interventionalist.  If implemented, this would ensure that the other guideline recommendations are more likely to be followed, with a better result for the most important person involved, the patient.