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Updated: Jul 8, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology 2023 Focused Update of the
Kevin R Bainey1, Guillaume Marquis-Gravel2, Emilie Belley-Côté3
1Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Insights
This focused update provides evidence-based recommendations for antiplatelet therapy (APT) strategies in atherosclerotic cardiovascular disease. It balances reducing cardiovascular events with managing bleeding risks for optimal patient care.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Antiplatelet therapy (APT) is crucial for preventing atherothrombotic events in atherosclerotic cardiovascular disease (ASCVD).
- Optimizing APT strategies requires balancing the reduction of major adverse cardiovascular events (MACE) with the risk of bleeding.
- Clinical trial evidence necessitates ongoing review to refine APT guidelines.
Framework:
- Focused update of Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology guidelines for APT.
- Recommendations based on systematic reviews and meta-analyses.
- Covers primary prevention, percutaneous coronary intervention (PCI), acute coronary syndrome (ACS), and atrial fibrillation (AF) management.
Implementation:
- Guidance on acetylsalicylic acid for primary ASCVD prevention.
- Dual APT (DAPT) duration recommendations for high bleeding risk patients post-PCI.
- P2Y12 inhibitor selection and de-escalation strategies for ACS patients post-PCI.
- DAPT protocols for medically treated ACS patients without revascularization.
- Pretreatment strategies with DAPT before coronary angiography.
- Perioperative and long-term APT management for coronary artery bypass grafting (CABG) surgery.
- APT use in patients with AF requiring oral anticoagulation post-PCI or medically managed ACS.
Implications:
- Aims to optimize APT selection for improved patient outcomes in ASCVD.
- Provides clinicians with updated, evidence-based guidance for complex patient scenarios.
- Facilitates informed decision-making in managing thrombotic and bleeding risks.
Abstract:
Antiplatelet therapy (APT) is the foundation of treatment and prevention of atherothrombotic events in patients with atherosclerotic cardiovascular disease. Selecting the optimal APT strategies to reduce major adverse cardiovascular events, while balancing bleeding risk, requires ongoing review of clinical trials. Appended, the focused update of the Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology guidelines for the use of APT provides recommendations on the following topics: (1) use of acetylsalicylic acid in primary prevention of atherosclerotic cardiovascular disease; (2) dual APT (DAPT) duration after percutaneous coronary intervention (PCI) in patients at high bleeding risk; (3) potent DAPT (P2Y12 inhibitor) choice in patients who present with an acute coronary syndrome (ACS) and possible DAPT de-escalation strategies after PCI; (4) choice and duration of DAPT in ACS patients who are medically treated without revascularization; (5) pretreatment with DAPT (P2Y12 inhibitor) before elective or nonelective coronary angiography; (6) perioperative and longer-term APT management in patients who require coronary artery bypass grafting surgery; and (7) use of APT in patients with atrial fibrillation who require oral anticoagulation after PCI or medically managed ACS. These recommendations are all on the basis of systematic reviews and meta-analyses conducted as part of the development of these guidelines, provided in the Supplementary Material.
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