July 30th, 2014
Heart Groups Update Guidelines on Stable Ischemic Heart Disease
Nicholas Downing, MD
The American College of Cardiology and the American Heart Association have issued a focused update to their 2012 guideline on diagnosing and managing patients with stable ischemic heart disease (IHD).
The update, published in the Journal of the College of Cardiology, includes a new section on the role of invasive coronary angiography for the diagnosis of coronary artery disease (CAD) in patients with suspected stable IHD. Angiography is:
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“useful” in patients with presumed stable IHD who continue to have “unacceptable” symptoms despite guideline-directed medical therapy and who are open to, and eligible for, coronary revascularization;
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“reasonable” to determine the extent of CAD in patients with suspected stable IHD who have a high likelihood of severe IHD based on clinical characteristics and noninvasive testing;
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“reasonable” in those with suspected symptomatic stable IHD who cannot undergo diagnostic stress testing when it’s likely that the findings will warrant “important changes to therapy.”
In addition, the groups now say that chelation is of uncertain value in reducing cardiovascular events in patients with stable IHD (the 2012 guideline said chelation was not recommended), and a heart team approach to revascularization is now advised for patients with diabetes and multivessel CAD.
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“reasonable” in those with suspected symptomatic stable IHD who cannot undergo diagnostic stress testing when it’s likely that the findings will warrant “important changes to therapy.”
Which patients with stable CAD cannot undergo diagnostic stress testing?