The South American Society of Cardiology (SSC) and the Latin American Association of Cardiac and Endovascular Surgery (LACES) Statement on the 2021 ACC/AHA/SCAI Guidelines for Coronary Artery Revascularization

Abstract

The Latin American Association of Cardiac and Endovascular Surgery (LACES), partnering with the South American Society of Cardiology (SSC), analyzing the 2021 American College of Cardiology (ACC)/American Heart Association (AHA)/Society for Cardiovascular Angiography and Interventions (SCAI) Guidelines for Coronary Artery Revascularization[1], has reached the conclusion that there is not enough evidence to endorse the recommendations included in its Chapter 7, focusing revascularization in stable ischemic heart disease. This decision is consistent with statements from other prestigious scientific societies: American Association of Thoracic Surgery[2], Society of Thoracic Surgery, Latin-American Association of Cardiac and Endovascular Surgery, European Association of Cardiothoracic Surgery, Japanese Society of Cardiovascular Surgery, and British Society of Cardiovascular Surgery; and it is mainly based on the downgrade of the class of recommendation (COR), from I to IIb, for coronary artery bypass grafting (CABG) as a treatment to improve survival in patients with stable three-vessel coronary artery disease (CAD) with preserved left ventricular function and no left main CAD. This statement is of paramount importance since this change in the level of recommendation dismissing the survival benefit of CABG in this scenario may result in compromise of medical coverage for millions of patients worldwide and particularly in Latin America whom otherwise could benefit from this intervention.