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[ESC/EACTS guidelines on myocardial revascularization 2018 : The most important innovations]
F-J Neumann1, W Hochholzer2, M Siepe3
1Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg ∙ Bad Krozingen, Südring 15, 79189, Bad Krozingen, Deutschland. Franz-Josef.Neumann@universitaets-herzzentrum.de.
Insights
Guidelines for myocardial revascularization emphasize functional assessment of coronary stenoses for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Optimal strategy considers completeness, risks, and coronary artery disease complexity.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- 2018 guidelines for myocardial revascularization are a joint initiative of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery.
- Establishing indications for revascularization requires assessing the functional significance of coronary artery stenoses.
Purpose of the Study:
- To outline the criteria for selecting the optimal myocardial revascularization strategy.
- To detail the recommended approaches for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
Main Methods:
- Utilizing evidence from non-invasive imaging or intravascular hemodynamic measurements to determine functional relevance of stenoses.
- Assessing individual operative risk, technical feasibility, diabetes mellitus, and coronary artery disease complexity (e.g., SYNTAX score).
Main Results:
- Complete revascularization is crucial for achieving prognostic and symptomatic benefits.
- PCI recommendations include radial artery access and drug-eluting stents.
- CABG recommendations emphasize multiple arterial grafts, including the radial artery for high-grade stenoses.
Conclusions:
- The choice of revascularization strategy (PCI or CABG) must be individualized.
- Functional assessment and comprehensive patient/disease evaluation are paramount for successful outcomes.
Abstract:
The guidelines on myocardial revascularization published in 2018 are a joint initiative of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery. To establish indications for myocardial revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), evidence of the functional relevance of coronary artery stenoses is needed either by non-invasive imaging function tests or intravascular hemodynamic measurements. The prognostic and symptomatic benefits of myocardial revascularization depend on whether complete revascularization can be achieved. This needs to be considered when choosing the most appropriate revascularization strategy. In addition, the individual operative risk, the technical feasibility, the presence of diabetes mellitus and the anatomical complexity of coronary artery disease, as assessed by the SYNTAX score, are key criteria when choosing the optimal method of revascularization. For PCI radial artery access and the general use of drug-eluting stents are recommended. For CABG multiple arterial grafts should be strived for including the radial artery for treatment of high-grade coronary stenosis.
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