《2012年冠状动脉血运重建术应用标准》内容预览：

    This report is a focused update of the AUC for coronaryrevascularization published in 2009 (1). The increasingprevalence of coronary artery disease (CAD), continuedadvances in surgical and percutaneous techniques for revas-cularization and concomitant medical therapy for CAD,and the costs of revascularization have resulted in height-ened interest regarding the appropriate use of coronaryrevascularization. Clinicians, payers, and patients are inter-ested in the specific benefits of revascularization. Inappro-priate revascularization may be harmful to patients andgenerate unwarranted costs to the healthcare system,whereas appropriate revascularization procedures can im-prove patients’ clinical outcomes.
  
    As in the original AUC document, the same classificationscheme with ratings of appropriate, uncertain, and inappro-priate was used. The uncertain category can cause confusionin the interpretation of the AUC and can imply severalmeanings within its definition. First, the rating of uncertainis used when pertinent literature is either not available orwhen true discrepancies exist. Second, it is impossible toinclude every relevant piece of clinical ***rmation (e.g., age,sex, diabetes) in the individual clinical scenarios. Attempt-ing to do that may result in an unmanageable number ofclinical scenarios and thus compromise the usefulness of theAUC in daily practice. The practice of medicine is full ofuncertainties that require a thoughtful clinician to use his orher best judgment about each patient to reach decisionsabout management. Therefore, a rating of uncertain may beassigned by members of the technical panel if clinical***rmation not provided might affect their individualrating, causing a shift into either the appropriate or inap-propriate category.
  
    A rating of uncertain means simply what the nameimplies, and depending on additional factors, it can beappropriate or inappropriate to perform revascularization.The writing group emphasizes that uncertain indications arenot inappropriate. Rather, they reflect clinical scenarios thatare reasonable for performing revascularization, but addi-tional clinical factors should be considered or further re-search is needed to more definitively define the benefits oftreatment for patients.

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