The best place to start in reviewing Resource (1) the Myocardial Revascularization Clinical Practice Guidelines (2018) [PubMed Abstract][Full Text HTML] [Full Text PDF] from the European Society of Cardiology is actually to review Resource (2) which I have excerpted below.
Resource (2) the Medscape review article Myocardial Revascularization Clinical Practice Guidelines (2018) Reviewed and summarized by Medscape editors, September 14, 2018.
So here are some excerpts from the summary article [Resource (2)]:
The clinical practice guidelines on myocardial revascularization were released on August 25, 2018, by the ESC/EACTS, in collaboration with the EAPCI.[1,2]
Myocardial revascularization is recommended for patients who have severe LV systolic dysfunction and coronary artery disease that is suitable for intervention.
Coronary artery bypass grafting (CABG) is recommended as the first revascularization procedure in patients with multivessel disease who are of acceptable risk.
CABG is recommended in patients with a primary indication for aortic/mitral valve surgery and coronary artery diameter stenosis >70%.
In patients undergoing CABG, carotid duplex ultrasonography is recommended in patients with a history of stroke or transient ischemic attack <6 months.
Emergency coronary angiography is indicated in patients with acute coronary syndrome that is complicated by acute heart failure or cardiogenic shock.
If left main or multivessel revascularization is being considered, calculate the SYNTAX score (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery)* to predict whether PCI can achieve similar benefits to CABG.
* This link is to the to the SYNTAX Score website.
The SYNTAX Score is a unique tool to score complexity of coronary artery disease. As it is very important to use this scoring tool correctly, it is strongly recommended to complete the tutorial before first use. [from the above website]
Resuming excerpts from the Resource (2) summary:
The SYNTAX score is the recommended tool to gauge the anatomic complexity of coronary disease.
Percutaneous coronary intervention (PCI) of the culprit lesion is the mainstay of ACS treatment.
Drug-eluting stents (DES) are recommended for any PCI regardless of the clinical presentation, type of lesion, anticipated duration of dual antiplatelet therapy (DAPT), or anticoagulant therapy.
For more complex disease, surgery provides better long-term survival.
CABG and PCI have similar outcomes in less complex cases.
In patients with diabetes, surgery is associated with better outcomes regardless of the complexity of the disease.
Radial access is recommended as the standard approach for coronary angiography and PCI.
Drug-eluting stents are recommended for all PCI procedures.
CABG is preferred to achieve myocardial revascularization in patients with coronary artery disease, heart failure, and left ventricular ejection fraction ≤35%.
Patients who have undergone myocardial revascularization should undergo systematic re-evaluation.
Consider PCI as an alternative to CABG, but the completeness of revascularization should be prioritized.
Operator volume for left main PCI should be ≥25 cases/yr.
Non–vitamin K oral anticoagulants should be given over vitamin K antagonists in patients with nonvalvular atrial fibrillation who require anticoagulation and antiplatelet treatment.
Cangrelor should be given to patients who are P2Y12-inhibitor naive who are undergoing PCI; glycoprotein IIb/IIIa inhibitors should be given to patients with ACS.
After PCI, dabigatran 150 mg is preferred over 100 mg when it is combined with single antiplatelet therapy.
In high-risk patients, routine noninvasive imaging surveillance should be done 6 months after revascularization.
Resources:
(1) Myocardial Revascularization Clinical Practice Guidelines (2018) [PubMed Abstract][Full Text HTML] [Full Text PDF] from the European Society of Cardiology.
(2) Myocardial Revascularization Clinical Practice Guidelines (2018) Reviewed and summarized by Medscape editors, September 14, 2018
(3) SYNTAX Score website.
The SYNTAX Score is a unique tool to score complexity of coronary artery disease. As it is very important to use this scoring tool correctly, it is strongly recommended to complete the tutorial before first use. [from the above website]
(4) Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease [PubMed Abstract] [Full Text HTML] [Full Text PDF]. N Engl J Med. 2009 Mar 5;360(10):961-72. doi: 10.1056/NEJMoa0804626. Epub 2009 Feb 18.
(5) Coronary Revascularization in Context [Editorial] [Full Text HTML]. N Engl J Med 2009; 360:1024-1026 DOI: 10.1056/NEJMe0900452.
