Accurate understanding of the changes in the recommendations on coronary artery bypass grafting and radial artery in the 2021 ACC/AHA/SCAI Guideline For Coronary Artery Revascularization

Abstract

The 2021 ACC/AHA/SCAI Guideline For Coronary Artery Revascularization has been brought into focus and widely questioned by multiple associations of cardiac surgeons around the world, in which the class of recommendation (COR) for coronary artery bypass grafting (CABG) was downgraded from Ⅰ to Ⅱb in the treatment of 3 vessel coronary artery disease, and the use of radial artery as CABG conduit was elevated to COR Ⅰ. The ISCHEMIA trial, which was cited by the guidelines as evidence, had obvious selection bias. It did not consider the advantages of long-term patency rate of CABG in patients with high risk factors, and did not define that radial artery bypass has a certain applicable population. Only by widely collecting and carefully selecting evidence and collaborating with cardiac surgeons in the multidisciplinary team of coronary heart disease, the more reasonable and comprehensive guidelines and suggestions could be formed.