2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

HomeCirculationVol. 145, No. 32021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUB2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Jennifer S. Lawton, MD, FAHA, Chair, Jacqueline E. Tamis-Holland, MD, FAHA, FACC, FSCAI, Vice Chair, Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Eric R. Bates, MD, FACC, FAHA, Theresa M. Beckie, PhD, FAHA, James M. Bischoff, MEd, John A. Bittl, MD, FACC, Mauricio G. Cohen, MD, FACC, FSCAI, J. Michael DiMaio, MD, Creighton W. Don, MD, PhD, FACC, Stephen E. Fremes, MD, FACC, Mario F. Gaudino, MD, PhD, MSCE, FACC, FAHA, Zachary D. Goldberger, MD, FACC, FAHA, Michael C. Grant, MD, MSE, Jang B. Jaswal, MS, Paul A. Kurlansky, MD, FACC, Roxana Mehran, MD, FACC, Thomas S. Metkus Jr, MD, FACC, Lorraine C. Nnacheta, DrPH, MPH, Sunil V. Rao, MD, FACC, Frank W. Sellke, MD, FACC, FAHA, Garima Sharma, MD, FACC, Celina M. Yong, MD, MBA, MSc, FSCAI, FACC, FAHA and Brittany A. Zwischenberger, MD Jennifer S. LawtonJennifer S. Lawton , Jacqueline E. Tamis-HollandJacqueline E. Tamis-Holland , Sripal BangaloreSripal Bangalore , Eric R. BatesEric R. Bates , Theresa M. BeckieTheresa M. Beckie , James M. BischoffJames M. Bischoff , John A. BittlJohn A. Bittl , Mauricio G. CohenMauricio G. Cohen , J. Michael DiMaioJ. Michael DiMaio , Creighton W. DonCreighton W. Don , Stephen E. FremesStephen E. Fremes , Mario F. GaudinoMario F. Gaudino , Zachary D. GoldbergerZachary D. Goldberger , Michael C. GrantMichael C. Grant , Jang B. JaswalJang B. Jaswal , Paul A. KurlanskyPaul A. Kurlansky , Roxana MehranRoxana Mehran , Thomas S. Metkus JrThomas S. Metkus Jr , Lorraine C. NnachetaLorraine C. Nnacheta , Sunil V. RaoSunil V. Rao , Frank W. SellkeFrank W. Sellke , Garima SharmaGarima Sharma , Celina M. YongCelina M. Yong and Brittany A. ZwischenbergerBrittany A. Zwischenberger Originally published9 Dec 2021https://doi.org/10.1161/CIR.0000000000001038Circulation. 2022;145:e18–e114is corrected byCorrection to: 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: March 18, 2022: Previous Version of Record January 18, 2022: Previous Version of Record December 9, 2021: Ahead of Print ContentsAbstract e18Top 10 Take-Home Messages e20Preamble e211. Introduction e221.1. Methodology and Evidence Review e221.2. Organization of the Writing Committee e241.3. Document Review and Approval e241.4. Scope of the Guideline e241.5. Class of Recommendation and Level of Evidence e251.6. Abbreviations e252. Improving Equity of Care in Revascularization and Shared Decision-Making e262.1. Improving Equity of Care in Revascularization e262.2. Shared Decision-Making and Informed Consent e273. Preprocedural Assessment and the Heart Team e293.1. The Heart Team e293.2. Predicting Patient Risk of Death With CABG e304. Defining Lesion Severity e304.1. Angiography to Define Anatomy and Assess Lesion Severity e304.2. Defining Coronary Artery Lesion Complexity: Calculation of the SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) Score e314.3. Use of Coronary Physiology to Guide Revascularization With PCI e314.4. Intravascular Ultrasound to Assess Lesion Severity e325. Revascularization in STEMI e335.1. Revascularization of the Infarct Artery in Patients With STEMI e335.2. Revascularization of the Non-Infarct Artery in Patients With STEMI e356. Revascularization in Non–ST-Segment–Elevation Acute Coronary Syndrome (NSTE-ACS) e386.1. Coronary Angiography and Revascularization in Patients with NSTE-ACS e387. Revascularization in SIHD e407.1. Revascularization to Improve Survival in SIHD Compared With Medical Therapy e407.2. Revascularization to REDUCE Cardiovascular Events in SIHD Compared with Medical Therapy e437.3. Revascularization to Improve Symptoms e448. Situations in Which PCI or CABG Would Be Preferred e448.1. Patients With Complex Disease e448.2. Patients With Diabetes e458.3. Patients With Previous CABG e468.4. DAPT Adherence e479. Special Populations and Situations e479.1. Revascularization in Pregnant Patients e479.2. Revascularization in Older Patients e479.3. Revascularization in Patients With Chronic Kidney Disease (CKD) e489.4. Revascularization in Patients Before Noncardiac Surgery e499.5. Revascularization in Patients to Reduce Ventricular Arrhythmias e509.6. Revascularization in Patients With SCAD e509.7. Revascularization in Patients With Cardiac Allografts e519.8. Revascularization in Patients Before Transcatheter Aortic Valve Replacement (TAVR) e519.9. Revascularization in Patients With Anomalous Coronary Artery e5110. General Procedural Issues for PCI e5210.1. Radial and Femoral Approaches for PCI e5210.2. Choice of Stent Type e5210.3. Use of Intravascular Imaging e5310.4. Thrombectomy e5410.5. Treatment of Calcified Lesions e5410.6. Treatment of Saphenous Vein Graft (SVG) Disease (Previous CABG) e5510.7. Treatment of CTO e5610.8. Treatment of Patients With Stent Restenosis e5610.9. Hemodynamic Support for Complex PCI e5711. Pharmacotherapy in Patients Undergoing PCI e5711.1. Aspirin and Oral P2Y12 Inhibitors in Patients Undergoing PCI e5711.2. Intravenous P2Y12 Inhibitors in Patients Undergoing PCI e6011.3. Intravenous Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing PCI e6011.4. Heparin, Low-Molecular-Weight Heparin, and Bivalirudin in Patients Undergoing PCI e6112. General Procedural Issues for CABG e6212.1. Perioperative Considerations in Patients Undergoing CABG e6212.2. Bypass Conduits in Patients Undergoing CABG e6312.3. CABG in Patients Undergoing Other Cardiac Surgery e6412.4. Use of Epiaortic Ultrasound in Patients Undergoing CABG e6512.5. Use of Cardiopulmonary Bypass in Patients Undergoing CABG e6613. Pharmacotherapy in Patients Undergoing CABG e6613.1. Insulin Infusion and Other Measures to Reduce Sternal Wound Infection in Patients Undergoing CABG e6613.2. Antiplatelet Therapy in Patients Undergoing CABG e6813.3. Beta Blockers and Amiodarone in Patients Undergoing CABG e6914. Pharmacotherapy in Patients After Revascularization e7014.1. Pharmacotherapy for Risk Factor Control in Patients After Revascularization e7014.2. Dual Antiplatelet Therapy in Patients After PCI e7014.3. Antiplatelet Therapy in Patients After CABG e7014.4. Beta Blockers in Patients After Revascularization e7214.5. Beta Blockers for the Prevention of Atrial Fibrillation After CABG e7214.6. Antiplatelet Therapy in Patients With Atrial Fibrillation on Anticoagulation After PCI e7315. Recommendations for Addressing Psychosocial Factors and Lifestyle Changes After Revascularization e7315.1. Cardiac Rehabilitation and Education e7315.2. Smoking Cessation in Patients After Revascularization e7415.3. Psychological Interventions in Patients After Revascularization e7616. Revascularization Outcomes e7616.1. Assessment of Outcomes in Patients After Revascularization e7617. Unanswered Questions and Future Directions e7717.1. Special Populations e7717.1.1. Underrepresented Racial and Ethnic Groups e7717.2. Special Clinical Situations e7717.2.1. Left Ventricular Dysfunction e7717.2.2. SCAD e7817.2.3. Coronary Artery Aneurysm e7817.2.4. Myocardial Bridging e7817.2.5. Treatment of Graft Failure e7817.2.6. Antiplatelet Therapy in Patients With ACS After CABG With an Indication for Anticoagulation e7817.3. Revascularization Considerations e7817.3.1. Use of the Radial Artery for a Conduit After Radial Artery Catheterization e7817.3.2. Completeness of Revascularization in Multivessel Disease e7917.3.3. Hybrid Coronary Surgery e7917.3.4. Revascularization Before Percutaneous Valve Procedures e7917.3.5. Revascularization Before Organ Transplantation e79References e80Appendix 1 Author Relationships With Industry and Other Entities (Relevant) e110Appendix 2 Reviewer Relationships With Industry and Other Entities (Comprehensive) e112Top 10 Take-Home MessagesTreatment decisions regarding coronary revascularization in patients with coronary artery disease should be based on clinical indications, regardless of sex, race, or ethnicity, because there is no evidence that some patients benefit less than others, and efforts to reduce disparities of care are warranted.In patients being considered for coronary revascularization for whom the optimal treatment strategy is unclear, a multidisciplinary Heart Team approach is recommended. Treatment decisions should be patient centered, incorporate patient preferences and goals, and include shared decision-making.For patients with significant left main disease, surgical revascularization is indicated to improve survival relative to that likely to be achieved with medical therapy. Percutaneous revascularization is a reasonable option to improve survival, compared with medical therapy, in selected patients with low to medium anatomic complexity of coronary artery disease and left main disease that is equally suitable for surgical or percutaneous revascularization.Updated evidence from contemporary trials supplement older evidence with regard to mortality benefit of revascularization in patients with stable ischemic heart disease, normal left ventricular ejection fraction, and triple-vessel coronary artery disease. Surgical revascularization may be reasonable to improve survival. A survival benefit with percutaneous revascularization is uncertain. Revascularization decisions are based on consideration of disease complexity, technical feasibility of treatment, and a Heart Team discussion.The use of a radial artery as a surgical revascularization conduit is preferred versus the use of a saphenous vein conduit to bypass the second most important target vessel with significant stenosis after the left anterior descending coronary artery. Benefits include superior patency, reduced adverse cardiac events, and improved survival.Radial artery access is recommended in patients undergoing percutaneous intervention who have acute coronary syndromes or stable ischemic heart disease, to reduce bleeding and vascular complications compared with a femoral approach. Patients with acute coronary syndromes also benefit from a reduction in mortality rate with this approach.A short duration of dual antiplatelet therapy after percutaneous revascularization in patients with stable ischemic heart disease is reasonable to reduce the risk of bleeding events. After consideration of recurrent ischemia and bleeding risks, select patients may safely transition to P2Y12 inhibitor monotherapy and stop aspirin after 1 to 3 months of dual antiplatelet therapy.Staged percutaneous intervention (while in hospital or after discharge) of a significantly stenosed nonculprit artery in patients presenting with an ST-segment–elevation myocardial infarction is recommended in select patients to improve outcomes. Percutaneous intervention of the nonculprit artery at the time of primary percutaneous coronary intervention is less clear and may be considered in stable patients with uncomplicated revascularization of the culprit artery, low-complexity nonculprit artery disease, and normal renal function. In contrast, percutaneous intervention of the non-culprit artery can be harmful in patients in cardiogenic shock.Revascularization decisions in patients with diabetes and multivessel coronary artery disease are optimized by the use of a Heart Team approach. Patients with diabetes who have triple-vessel disease should undergo surgical revascularization; percutaneous coronary intervention may be considered if they are poor candidates for surgery.Treatment decisions for patients undergoing surgical revascularization of coronary artery disease should include the calculation of a patient’s surgical risk with the Society of Thoracic Surgeons score. The usefulness of the SYNTAX score calculation in treatment decisions is less clear because of the interobserver variability in its calculation and its absence of clinical variables.PreambleSince 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, which are based on systematic methods to evaluate and classify evidence, provide a foundation for the delivery of quality cardiovascular care. The ACC and AHA sponsor the development and publication of clinical practice guidelines without commercial support, and members volunteer their time to the writing and review efforts. Guidelines are official policy of the ACC and AHA. For some guidelines, the ACC and AHA partner with other organizations.Intended UseClinical practice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease (CVD). The focus is on medical practice in the United States, but these guidelines are relevant to patients throughout the world. Although guidelines may be used to inform regulatory or payer decisions, the intent is to improve quality of care and align with patients’ interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances and should not replace clinical judgment.Clinical ImplementationManagement, in accordance with guideline recommendations, is effective only when followed by both practitioners and patients. Adherence to recommendations can be enhanced by shared decision-making between clinicians and patients, with patient engagement in selecting interventions on the basis of individual values, preferences, and associated conditions and comorbidities.Methodology and ModernizationThe ACC/AHA Joint Committee on Clinical Practice Guidelines (Joint Committee) continuously reviews, updates, and modifies guideline methodology on the basis of published standards from organizations, including the Institute of Medicine,1,2 and on the basis of internal reevaluation. Similarly, presentation and delivery of guidelines are reevaluated and modified in response to evolving technologies and other factors to optimally facilitate dissemination of information to health care professionals at the point of care.Numerous modifications to the guidelines have been implemented to make them shorter and enhance “user-friendliness.” Guidelines are written and presented in a modular, “knowledge chunk” format, in which each chunk includes a table of recommendations, a brief synopsis, recommendation-specific supportive text and, when appropriate, flow diagrams or additional tables. Hyperlinked references are provided for each modular knowledge chunk to facilitate quick access and review.In recognition of the importance of cost–value considerations, in certain guidelines, when appropriate and feasible, an analysis of value for a drug, device, or intervention may be performed in accordance with the ACC/AHA methodology.3To ensure that guideline recommendations remain current, new data will be reviewed on an ongoing basis by the writing committee and staff. Going forward, targeted sections or knowledge chunks will be revised dynamically after publication and timely peer review of potentially practice-changing science. The previous designations of “full revision” and “focused update” will be phased out. For additional information and policies on guideline development, readers may consult the ACC/AHA guideline methodology manual4 and other methodology articles.5-7Selection of Writing Committee MembersThe Joint Committee strives to ensure that the guideline writing committee contains requisite content expertise and is representative of the broader cardiovascular community by selection of experts across a spectrum of backgrounds, representing different geographic regions, sexes, races, ethnicities, intellectual perspectives/biases, and clinical practice settings. Organizations and professional societies with related interests and expertise are invited to participate as partners or collaborators.Relationships With Industry and Other EntitiesThe ACC and AHA have rigorous policies and methods to ensure that documents are developed without bias or improper influence. The complete policy on relationships with industry and other entities (RWI) can be found online. Appendix 1 of the guideline lists writing committee members’ relevant RWI; for the purposes of full transparency, their comprehensive disclosure information is available in a Supplemental Appendix. Comprehensive disclosure information for the Joint Committee is also available online.Evidence Review and Evidence Review CommitteesIn developing recommendations, the writing committee uses evidence-based methodologies that are based on all available data.4,5 Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Only key references are cited.An independent evidence review committee is commissioned when there are ≥1 questions deemed of utmost clinical importance and merit formal systematic review to determine which patients are most likely to benefit from a drug, device, or treatment strategy, and to what degree. Criteria for commissioning an evidence review committee and formal systematic review include absence of a current authoritative systematic review, feasibility of defining the benefit and risk in a time frame consistent with the writing of a guideline, relevance to a substantial number of patients, and likelihood that the findings can be translated into actionable recommendations. Evidence review committee members may include methodologists, epidemiologists, clinicians, and biostatisticians. Recommendations developed by the writing committee on the basis of the systematic review are marked.“SR”Guideline-Directed Management and TherapyThe term guideline-directed medical therapy (GDMT) encompasses clinical evaluation, diagnostic testing, and both pharmacological and procedural treatments. For these and all recommended drug treatment regimens, the reader should confirm dosage with product insert material and evaluate for contraindications and interactions. Recommendations are limited to drugs, devices, and treatments approved for clinical use in the United States.Patrick T. O’Gara, MD, MACC, FAHAChair, ACC/AHA Joint Committee on Clinical Practice Guidelines1. Introduction1.1. Methodology and Evidence ReviewThe recommendations listed in this guideline are, whenever possible, evidence based. An initial extensive evidence review, which included literature derived from research involving human subjects, published in English, and indexed in the US National Library of Medicine and the National Center for Biotechnology information (through PubMed), EMBASE, the Cochrane Collaboration, CINHL Complete, and other selected databases relevant to this guideline, was conducted from May 2019 to September 2019. Key search words included but were not limited to the following: percutaneous coronary intervention, angioplasty, coronary artery bypass graft (CABG) surgery, myocardial infarction, cardiac surgery, stent(s), angiogram, angiography, percutaneous transluminal coronary angioplasty, coronary atherosclerosis, saphenous vein graft, internal mammary artery (IMA) graft, internal thoracic artery graft, arterial graft, post-bypass, non-ST elevated myocardial infarction, vein graft lesions, myocardial revascularization, multivessel PCI, and left ventricular dysfunction. Additional relevant studies, published through May 2021 during the guideline writing process, were also considered by the writing committee and added to the evidence tables when appropriate. The final evidence tables are included in the Online Data Supplement and summarize the evidence used by the writing committee to formulate recommendations. References selected and published in the present document are representative and not all-inclusive.1.2. Organization of the Writing CommitteeThe writing committee consisted of clinicians, general cardiologists, interventional cardiologists, cardiac surgeons, a cardiac anesthesiologist, an advanced nurse practitioner, and 2 lay/patient representatives. The writing committee included representatives from the ACC, AHA, Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery, and Society of Thoracic Surgeons (STS). Appendix 1 of the present document lists writing committee members’ relevant RWI. For the purposes of full transparency, the writing committee members’ comprehensive disclosure information is available in a Supplemental Appendix.1.3. Document Review and ApprovalThis document was reviewed by 2 official reviewers each nominated by the ACC and AHA; 1 reviewer each from the ACC, AHA, STS, American Association for Thoracic Surgery, and SCAI; and 31 individual content reviewers. Reviewers’ RWI information was distributed to the writing committee and is published in Appendix 2.The present document was approved for publication by the governing bodies of the ACC, AHA, and SCAI.1.4. Scope of the GuidelineThe scope of the “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization” is to provide an update to and to consolidate the 2011 coronary artery bypass graft (CABG) surgery1 and the 2011 and 2015 percutaneous coronary intervention (PCI) guidelines,2,3 with the added consideration of using a patient-centric disease approach. The applicable sections on revascularization from the 2012 stable ischemic heart disease (SIHD) guideline,4 as well as the 2013 ST-segment–elevation myocardial infarction (STEMI)5 and 2014 non–ST-segment–elevation myocardial infarction (NSTEMI) guidelines,6 will also be updated. This present guideline will affect the following documents:Replace/retire the 2011 PCI guideline.2Replace/retire the 2011 CABG guideline.1Replace/retire the 2015 update in PCI in STEMI guideline.3Replace/retire the 2013 STEMI guideline, Sections 4.1, 4.2, 4.3, 4.4, 5.3 (deals with transfer after lytic with intent to do PCI), 6.2, 6.4, 7.1, and 7.2.5Replace/retire 2014 non–ST-segment–elevation acute coronary syndrome (NSTE-ACS) guideline, Sections 4.4.4, 5.1.1, 5.1.2.1, 5.1.2.2, 5.1.2.3, and 5.2.6Replace/retire the 2012 SIHD guideline, Section 5.4The intended primary target audience consists of cardiovascular clinicians who are involved in the care of patients for whom revascularization is considered or indicated. Coronary artery disease (CAD) is to be approached with the most current treatment options and treated as a “condition.” Recommendations are stated in reference to the patients and their condition. The focus is to provide the most up-to-date evidence to inform the clinician during shared decision-making with the patient. Although the document is not intended to be a procedural-based manual of recommendations that outlines the best practice for coronary revascularization, there are certain techniques that surgeons or interventional cardiologists might use that are associated with improved clinical outcomes.In developing the 2021 coronary artery revascularization guideline, the writing committee reviewed previously published guidelines and related statements. Table 1 contains a list of these publications and statements deemed pertinent to this writing effort and is intended for use as a resource, thus obviating the need to repeat existing guideline recommendations.Table 1. Associated Guidelines and StatementsTitleOrganizationPublication Year (Reference)Guidelines 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac DeathAHA/ACC/HRS20177 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart DiseaseACC/AHA20208 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular DiseaseACC/AHA20199 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac SurgeryACC/AHA201610 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood CholesterolAHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA201911 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart DiseaseAHA/ACC201912 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial FibrillationAHA/ACC/HRS201413 Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial FibrillationAHA/ACC/HRS201914 ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart DiseaseACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS201415 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction Levine et al., 2016 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction, is now replaced and retired by the present 2021 guideline.ACC/AHA20163 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary SyndromesAHA/ACC20146 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice GuidelinesACCF/AHA20135 2013 ACCF/AHA Guideline for the Management of Heart FailureACCF/AHA201316 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart FailureACC/AHA/HFSA201717 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery Hillis et al., 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, is now replaced and retired by the present 2021 guideline.ACCF/AHA20111 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention Levine et al., 2013 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, is now replaced and retired by the present 2021 guideline.ACCF/AHA/SCAI20132 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac DeathAHA/ACC/HRS20187 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in AdultsACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA201818 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart DiseaseACCF/AHA/ACP/AATS/PCNA/SCAI/STS20124Statements 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation TreatmentACC201819 Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff: A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update: A US Public Health Service ReportUS Public Health Service report200820 AATS Expert Consensus Review on Prevention and Management of Sternal Wound InfectionsAATS201621 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac RehabilitationACC/AHA201822 Spontaneous Coronary Artery Dissection: Current State of the ScienceAHA201823 Contemporary Management of Cardiogenic ShockAHA201724 Secondary Prevention After Coronary Artery Bypass Graft Surgery: A Scientific Statement From the American Heart AssociationAHA201525 Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2018ADA201826AACVPR indicates American Association of Cardiovascular and Pulmonary Rehabilitation; AAPA, American Association of Physician Assistants; AATS, American Association for Thoracic Surgery; ABC, Association of Black Cardiologists; ACC, American College of Cardiology; ACCF, American College of Cardiology Foundation; ACP, American College of Physicians; ACPM, American College of Preventive Medicine; ADA, American Diabetes Association; AGS, American Geriatrics Society; AHA, American Heart Association; APhA, American Public Health Association; ASE, American Society of Echocardiography; ASH, American Society of Hypertension; ASNC, American Society of Nuclear Cardiology; ASPC, American Society for Preventive Cardiology; HFSA, Heart Failure Society of America; HRS, Heart Rhythm Society; NLA, National Lipid Association; NMA, National Medical Association; PCNA, Preventive Cardiovascular Nurses Association; SCAI, Society for Cardiovascular Angiography and