Revascularization in chronic coronary syndrome: shifts in clinical practice guidelines

The optimal revascularization strategy for chronic coronary syndrome (CCS) is rapidly evolving due to emerging evidence and technological advancements. This review will discuss the guidelines for the management of CCS, examining how they align with and respond to recent high-quality studies. We will also discuss the evolution of the guidelines and highlight key differences.

While broad consensus exists between the most recent European and American guidelines, notable differences exist in the management of multivessel disease with preserved ejection fraction and left main disease. The role of the Heart Teams has become increasingly vital particularly when the guidelines do not fit the clinical scenarios, and the evidence is controversial.

Determining the optimal management strategy for patients with CCS requires careful consideration of anatomic complexity, comorbidities, and individual patient preferences. While advances in percutaneous coronary intervention (PCI) and medical therapy have been widely discussed, it is equally important to contextualize these with emerging innovations in surgical revascularization. Techniques such as multiple arterial grafting and minimally invasive surgical approaches represent significant progress in coronary artery bypass surgery. Randomized trials that compare state-of-the-art percutaneous and surgical revascularization techniques are thus needed.