Article Text

Download PDFPDF
Using guidelines for coronary revascularisation: how many are needed and are they any good?
  1. Department of Research and Development
  2. Kensington & Chelsea and Westminster Health Authority
  3. 50 Eastbourne Terrace, London W2 6LX, UK
  4. Department of Epidemiology and Public Health
  5. University College London Medical School
  6. 1–19 Torrington Place, London WC1E 6BT, UK
  7. Royal London and St Bartholomew's NHS Trust
  8. London EC1A 7BE, UK
  1. Dr Timmis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Gone are the days when guidelines could be ignored as cookbook medicine, the overweening influence of purchasers, or a simplistic view of the world with little value in practical patient management. Most would now accept the broad principle that it is a part of good clinical medicine to assess practice against standards linked explicitly to scientific evidence. In this issue Peters and Bredee1 discuss new guidelines from the Netherlands on coronary revascularisation and make a bold proposal for their use in practice. What sense are we to make of this among the plethora of guidelines and quality of care studies?

Guidelines: proliferation or unification?

Guidelines, scarce 10 years ago, now abound; most areas of suspected and proved coronary artery disease are now covered by one or more guideline. In the US, aspects of the invasive management of coronary disease are dealt with in procedure specific guidelines (on exercise electrocardiography, coronary angiography, angioplasty, stents, coronary artery bypass grafts) as well as guidelines for separate clinical presentations (chronic stable angina, unstable angina, acute myocardial infarction) issued by the American College of Cardiology/American Heart Association ( or Agency for Health Care Policy and Research. It is possible therefore that the care of a single cardiac patient may come under the remit of half a dozen different guidelines from the same organisation. The European Society of Cardiology ( has issued guidelines on the management of chronic stable angina and myocardial infarction, as has the British Cardiac Society ( Neither organisation has published guidelines specifically …

View Full Text