Jeffrey L. Anderson, MD, FACC, FAHA, Chair 

Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect 

Alice K. Jacobs, MD, FACC, FAHA, Immediate Past Chair 2009–2011 [§§][1]

Sidney C. Smith, Jr, MD, FACC, FAHA, Past Chair 2006–2008 [§§][1]

Cynthia D. Adams, MSN, APRN-BC, FAHA[§§][1]

Nancy M

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.

Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously.

A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules).

In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 .

View this table:

 Table 1 
Classes of recommendations



View this table:

 Table 2 
Levels of evidence



The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must be notified to the …

/pdf/guidelines-for-the-diagnosis-and-treatment-of-non-st-segment-4i7khpy8cj.pdf

Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes

The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic stable angina as of November 17, 2002





The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines regularly reviews existing guidelines to determine when an update or a full revision is needed This process gives priority to areas in which major changes in text, and particularly recommendations, are merited on the basis of new understanding or evidence Minor changes in verbiage and references are discouraged

The ACC/AHA/American College of Physicians–American Society of Internal Medicine (ACP-ASIM) Guidelines for the Management of Patients With Chronic Stable Angina, which were published in June 1999, have now been updated The full-text guideline incorporating the updated material is available on the Internet (wwwaccorg or wwwamericanheartorg) in both a track-changes version showing the changes in the 1999 guideline in strike-out (deleted text) and highlighting …

https://cdr.lib.unc.edu/downloads/bz60cz34d

ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina)

BACKGROUND Precise knowledge of the expected "normal" lumen diameter at a given coronary anatomic location is a first step toward developing a quantitative estimate of coronary disease severity that could be more useful than the traditional "percent stenosis." METHODS AND RESULTS Eighty-three arteriograms were carefully selected from among 9,160 consecutive studies for their smooth lumen borders indicating freedom from atherosclerotic disease. Of these, 60 men and 10 women had no abnormalities of cardiac function, seven men had idiopathic dilated cardiomyopathy, and six men had left ventricular hypertrophy associated with significant aortic stenosis. Lumen diameter was measured at 96 points in 32 defined coronary segments or major branches. Measurements were scaled to the catheter, corrected for imaging distortion, and had a mean repeat measurement error of 0.12 mm. When sex, anatomic dominance, and branch length were accounted for, normal lumen diameter at each of the standard anatomic points could usually be specified with a population variance of +/- 0.6 mm or less (SD) and coefficient of variation of less than 0.25 (SD/mean). For example, the left main artery measured 4.5 +/- 0.5 mm, the proximal left anterior descending coronary artery (LAD) 3.7 +/- 0.4 mm, and the distal LAD 1.9 +/- 0.4 mm. For the LAD, lumen diameter was not affected by anatomic dominance (right versus left), but for the right coronary artery, proximal diameter varied between 3.9 +/- 0.6 and 2.8 +/- 0.5 mm (p less than 0.01) and for the left circumflex, between 3.4 +/- 0.5 and 4.2 +/- 0.6 mm (p less than 0.01). Women had smaller epicardial arterial diameter than men (-9%; p less than 0.001), even after normalization for body surface area (p less than 0.01). Branch artery caliber was unaffected by the anatomic dominance but increased with branch length, expressed as a fraction of the origin-to-apex distance (p less than 0.001). Lumen diameter was not affected by age or by vessel tortuosity but was significantly increased among men with left ventricular hypertrophy (+ 17%; p less than 0.001) or dilated cardiomyopathy (+ 12%; p less than 0.001). CONCLUSIONS This is a reference normal data set against which to compare lumen dimensions in various pathological states. It should be of particular value in the investigation of diffuse atherosclerotic disease.

Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation.

A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.07.013

/pdf/2012-accf-aha-acp-aats-pcna-scai-sts-guideline-for-the-3rcj2i2kf5.pdf

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

The diameters of large epicardial coronary arteries were measured by quantitative cinearteriography in 99 patients. Average coronary size was larger than normal in patients with lesions associated with left ventricular hypertrophy and∕or dilation. The size of the coronary arteries supplying the left ventricle was normal in patients with pure mitral stenosis and in those with the “floppy mitral valve syndrome” (when mitral regurgitation was slight or absent). The left coronary artery was larger than the right coronary artery in 83% of cases. Measurement of coronary artery size is a simple and useful extension of coronary arteriography.

Human coronary artery size during life. A cinearteriographic study.

Echocardiography was used to differentiate left ventricular hypertrophy due to hypertrophic cardiomyopathy (20 cases) from that due to aortic valvular stenosis (10 cases) or systemic hypertension (10 cases). In aortic stenosis or hypertension symmetrical left ventricular hypertrophy was demonstrated with greater than normal thickness of both the ventricular septum and the posterior ventricular wall. The ratio of septal-to-posterior ventricular-wall thickness (mean ± S.D.) was the same as normal (1.2 ± 0.1). In hypertrophic cardiomyopathy, asymmetrical left ventricular hypertrophy was demonstrated with gross septal thickening (22.5 ± 3.4 mm) and a normal or slightly increased thickness of the posterior left ventricular wall (10.4 ± 2.0 mm). The ratio of septal-to-posterior left-ventricular-wall thickness (2.2 ± 0.2) was greater than that in aortic stenosis or systemic hypertension (p<0.005). The ventricular septum was disproportionately hypertrophied in hypertrophie cardiomyopathy regardless of th...

Left Ventricular Hypertrophy Diagnosed by Echocardiography

The basic premise of optimal angiography is to deliver the contrast material selectively to the arterial bed under investigation. This applies to the coronary arterial bed as well as other areas of the body. In 1959, Mason Sones reported his technic of selective catheterization of the coronary arteries with a specially designed catheter (9). The coronary angiograms Sones produced are of such excellence that all other methods must be compared and evaluated with reference to his results. We have modified his basic technic (7–9) by omitting the surgical exposure of the brachial artery and open arteriotomy and substituting instead the percutaneous transaxillary Seldinger approach (2, 6). Advantages of the percutaneous transaxillary approach include those of the Seldinger technic versus open arteriotomy: the ability to re-examine the patient via the same artery, if necessary, after review of the angiogram and on an annual basis to evaluate therapeutic programs. A technical advantage is the fact that the axilla...

Percutaneous transaxillary selective coronary angiography.

Dose reduction low pulse-rate fluoroscopy may be accomplished by integrating a magnetic video disk recorder into an x-ray system. Playback of the stored television image between x-ray pulses results in a flicker-free continuous image with actual dose reduction ranging from 2 to 60 times, depending on the pulse rate used. This system was applied successfully to cardiac catheterization and selective coronary arteriography, resulting in an estimated average dose reduction of over 2 times.

Dose reduction low pulse-rate fluoroscopy.

Treadmill exercise tests for capacity and adaptation in angina pectoris.

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