University of Miami interventional cardiologist Mauricio Cohen, M.D., has joined seasoned colleagues from around the U.S. to update the national coronary artery revascularization guidelines. These comprehensive recommendations will help cardiologists, interventional cardiologists and cardiac surgeons decide how to manage coronary artery disease and give their patients the best options to unblock blood vessels and restore healthy blood flow.
“These documents provide recommendations from many experts to improve care,” said Dr. Cohen, professor of medicine at the University of Miami Miller School of Medicine. “They integrate clinical trial and observational data to determine best practices in cardiovascular care.”
The Changing Medical Landscape
The revascularization guidelines were last revised in 2011, and a lot has changed, Dr. Cohen noted. There are more medical options for patients, such as PCSK9 inhibitors to lower cholesterol, novel drugs for diabetes management and new cardiovascular procedures. The revised document also combines recommendations for stent procedures and open-heart coronary bypass surgery, which were completely separate in the past.
The new guidelines offer clinicians an easy-to-use resource to answer questions and support patient care. Each recommendation is backed by a rationale summary and supporting evidence. Physicians can also access source studies to better understand specific guidelines. Clinicians now have a more digestible, one-stop source for critical information.
“These are much easier to work with than the previous guidelines,” Dr. Cohen said. “They provide key chunks of knowledge with self-contained recommendations, synopses and a summary of the clinical trials that support those choices. They are also much easier to update, which is really important since medicine is advancing so fast.”
The revised guidelines also support new techniques that have been proven safer for patients. One example is radial access. Historically, cardiologists have used the femoral artery in the groin to insert catheters and perform a wide range of procedures, such as stenting, to unclog blood vessels. With radial access, cardiologists insert catheters through an artery in the wrist.
“I have been an early adopter and strong advocate for radial access,” Dr. Cohen said. “I firmly believe this less-invasive approach is safer for patients. Now, it has been endorsed as a Class I recommendation in the revascularization guidelines, something I had hoped would happen for a long time.”
In addition to providing information about specific procedures, and when they are most beneficial for patients, the guidelines also reassert the importance of equitable care, noting that: “Treatment decisions with regard to coronary revascularization in patients with coronary artery disease should be based on clinical indications, regardless of sex, race, or ethnicity.”
Also, by bringing interventional and surgical approaches together in one volume, the authors seek to encourage greater collaboration between these specialties.
“The revised guidelines continue to emphasize the heart team concept, in which surgeons, cardiologists and interventional cardiologists work with patients to find the best approaches to restore blood flow to their heart,” Dr. Cohen said. “In many cases, it’s quite clear what to do. But there can be grey areas, and it’s important to come to a consensus based on the latest evidence.”
These revisions were initiated in 2019 and moved steadily forward, despite COVID-related restrictions. Dr. Cohen was one of 23 cardiovascular experts from around the country on the writing committee and feels honored to have participated.
“This was an incredibly important milestone in my career,” Dr. Cohen said. “It was a lot of work, certainly, but the guidelines we have put into place will do a lot of good for patients.”