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Myocardial revascularization : how have the guidelines changed our practice
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ESC/EACTS Guidelines on Myocardial Revascularisation

ESC Clinical Practice Guidelines

Chronic Ischaemic Heart Disease (IHD)
Cardiovascular Surgery
Guidelines version available to download
Published in 2014
Reference doi: 10.1093/eurheartj/ehu278
Published in 2014
Reference Pocket Guidelines Abriged version
PDA
Published in 2014
Reference MR Pocket Guidelins Mobile App
Published in 2014
Reference 36 CME Questions
Published in 2014
Reference Patient Information MR
Published in 2014
Reference Myocardial Revascularization Web Addenda
Table of contents: Full Text (ESC Clinical Practice Guidelines)

Preamble

Introduction

Scores and risk stratification

Process for decision-making and patient information

  • Patient information and informed consent
  • Multidisciplinary decision-making (heart team)
  • Timing of revascularization and ad hoc percutaneous coronary intervention

Strategies for diagnosis: functional testing and imaging

  • Non-invasive tests
  • Invasive tests
  • Detection of myocardial viability

Revascularization for stable coronary artery disease

  • Rationale for revascularization
  • Evidence basis for revascularization
    • Revascularization with the use of PCI
    • PCI with drug-eluting stents vs. bare-metal stents
    • Revascularization with the use of coronary artery bypass grafting
  • Percutaneous coronary intervention vs. coronary artery bypass grafting
    • Proximal left anterior descending coronary artery disease
    • Left main coronary artery disease
    • Three-vessel coronary artery disease

Revascularization in non-ST-segment elevation acute coronary syndromes

  • Early invasive vs. conservative strategy
  • Timing of angiography and intervention
  • Type of revascularization
    • Coronary artery bypass surgery
    • Percutaneous coronary intervention

Revascularization in ST-segment elevation myocardial Infarction

  • Time delays
  • Selection of reperfusion strategy
  • Primary percutaneous coronary intervention
  • Fibrinolysis
  • Secondary percutaneous coronary intervention
  • Coronary artery bypass surgery

Revascularization in patients with heart failure and cardiogenic shock

  • Chronic heart failure
    • Revascularization
    • Myocardial viability and revascularization
    • Ventricular reconstruction
  • Cardiogenic shock
    • Revascularization
    • Mechanical circulatory support
    • Right ventricular failure
    • Mechanical complications

Revascularization in patients with diabetes

  • Evidence for myocardial revascularization
    • Stable coronary artery disease
    • Acute coronary syndromes
  • Type of myocardial revascularization
    • Randomized clinical trials
    • Meta-analyses
  • Revascularization with the use of percutaneous coronary intervention
  • Revascularization with the use of coronary artery bypass grafting
  • Antithrombotic pharmacotherapy
  • Anti-diabetic medications

Revascularization in patients with chronic kidney disease

  • Evidence-base for revascularization
    • Patients with moderate chronic kidney disease
    • Patients with severe chronic kidney disease and end-stage renal disease or in haemodialysis
  • Prevention of contrast-induced nephropathy

Revascularization in patients requiring valve interventions

  • Primary indication for valve interventions
  • Primary indication for coronary revascularization

Associated carotid/peripheral artery disease

  • Associated coronary and carotid artery disease
    • Risk factors for stroke associated with myocardial revascularization
    • Preventive measures to reduce the risk of stroke after CABG
    • Carotid revascularization in patients scheduled for myocardial revascularization
    • Type of revascularization in patients with associated carotid and coronary artery disease
  • Associated coronary and peripheral arterial disease

Repeat revascularization and hybrid procedures

  • Early graft failure
  • Disease progression and late graft failure
  • Repeat percutaneous coronary intervention
  • Hybrid procedures

Arrhythmias

  • Ventricular arrhythmias
    • Revascularization for prevention of sudden cardiac death in patients with stable coronary artery disease and reduced left ventricular function
    • Revascularization for treatment of electrical storm
    • Revascularization after out-of-hospital cardiac arrest
  • Atrial arrhythmias
    • Atrial fibrillation complicating percutaneous coronary intervention
    • Atrial fibrillation complicating coronary artery bypass grafting
    • Post-operative atrial fibrillation and stroke risk
  • Concomitant surgical procedures for atrial fibrillation or stroke treatment

Procedural aspects of coronary artery bypass grafting

  • Pre-operative management
  • Blood management
    • Blood salvage interventions
    • Pharmacological strategies
    • Blood transfusion
  • Surgical procedures
    • Conduit harvest
    • Coronary vessel
    • Completeness of revascularization
    • Construction of central anastomosis
    • Bypass grafts
    • On-pump and off-pump procedures
    • Minimally invasive procedures
  • Reporting perioperative outcome

Procedural aspects of percutaneous coronary intervention

  • Percutaneous coronary intervention devices
    • Balloon angioplasty
    • Coronary stents
    • Bioresorbable scaffoldsstents
    • Drug-coated balloons
    • Other devices
  • Adjunctive invasive diagnostic tools
    • Intravascular ultrasound
    • Optical coherence tomography
    • Pressure-derived fractional flow reserve
  • Specific lesion subsets
    • Bifurcation stenosis
    • Chronic total coronary occlusion
    • Ostial lesions

Antithrombotic treatments

  •  Percutaneous coronary intervention in stable coronary artery disease
    • Oral antiplatelet therapy
    • Intravenous antiplatelet therapy
    • Anticoagulation       
  • Non-ST-segment elevation acute coronary syndrome
    • Oral antiplatelet therapy      
    • Intravenous antiplatelet therapy
    • Anticoagulation      
  • ST-segment elevation myocardial infarction
    • Oral antiplatelet therapy        
    • Intravenous antiplatelet therapy
    • Anticoagulation
  • Points of interest and special conditions
    • Pre-treatment with P2Y12 inhibitors
    • Intravenous P2Y12 inhibitors
    • Anticoagulation after PCI in acute coronary syndrome patients
    • Anticoagulation during PCI in patients on oral anticoagulation
    • Antithrombotic therapy after PCI in patients requiring oral anticoagulation
    • Duration of dual antiplatelet therapy after percutaneous coronary intervention
    • Drug interactions: a clopidogrel-related topic
    • Renal dysfunction
    • Surgery in patients on dual antiplatelet therapy
    • Antiplatelet therapy monitoring and genetic testing
    • Patients with hypersensitivity to acetylsalicylic acid
    • Heparin-induced thrombocytopaenia

Volume–outcome relationship for revascularization procedures

  • Coronary artery bypass grafting
  • Percutaneous coronary intervention

Medical therapy, secondary prevention, and strategies for follow-up

Appendix

References

 


 

 

 

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