Myocardial Revascularisation (Guidelines for)

Topics: Acute Coronary Syndromes (ACS)

Summary

Authors

William Wijns FESC (Chairperson), Philippe Kolh FESC (Chairperson), Nicolas Danchin FESC, Carlo Di Mario FESC, Volkmar Falk, Thierry Folliguet, Scot Garg, Kurt Hubert, Stefan James FESC, Juhani Knuuti FESC, Jose Lopez-Sendon, Jean Marco FESC, Lorenzo Menicanti, Miodrag Ostojic FESC, Massimo F. Piepoli FESC, Charles Pirlet, Jose L. Pomar, Nicolaus Reifart FESC, Flavio L. Ribichini, Martin J. Schalij FESC, Paul Sergeant, Patrick W. Serruys FESC,Sigmund Silber FESC, Miguel Sousa Uva FESC, David Taggart

Declarations of Interest of the experts involved in the elaboration of the document.

Endorsement by non ESC Entities

Swiss Society of Cardiac Surgery
Society for Cardiothoracic Surgery of Great Britain and Ireland
Israel Society of Cardiothoracic Surgery
Italian Society of Cardiac Surgery
German Society for Thoracic and Cardiovascular Surgery
Belgian Association for Cardio-Thoracic Surgery (BACTS)
Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular

Table of contents: Full Text (ESC Clinical Practice Guidelines)

Preamble and Introduction

Scores and risk stratification, impact of comoborbidity

Process for decision making & patient information

• Patient information
• Multidisciplinary decision making (Heart Team)

Strategies for pre-intervention diagnosis and imlaging

• Detection of coronary artery disease
• Detection of ischaemia
• Hybrid/combined imaging
• Invasive tests
• Prognostic value
• Detection of myocardial viability

Revascularization for stabe CAD

• Evidence basis for revascularisation
• Impact of ischaemia burden on prognosis
• Optimal medical therapy vs PCI
• PCI with drug-eluting stents vs bare metal stents
• Coronary artery bypass grafting vs medical therapy
• PCI vs coronary artery bypass grafting
• Recommendations

Revascularization in non-ST-segment elevation ACS

• Intended early invasive or conservative strategies
• Risk stratification
• Timing of angiography & intervention
• Coronary angiography, PCI, & coronary artery bypass grafting
• Patient subgroups

Revascularisation in St-segment elevation myoacardial infraction

• Reperfusion strategies
• Cardiogenic shock and mechanical complications

Special conditions

• Diabetes
• Myocardial revascularization in patients with chronic kidney disease
• Myocardial revascularisation in patients requiring valve surgery
• Associated carotid/peripheral arterial disease
• Myocardial revascularisation in CHF
• Crossed revascularisation procedures
• Arrhythmias in patients with ischaemic heart disease

Procedural aspects of coronary artery bypass grafting

• Pre-operative management
• Surgical procedures
• Early post-operative risk

Procedural aspects of PCI

• Impact of clinical presentation
• Specific lesion subsets
• Drug-eluting stents
• Adjunctive invasive diagnostic tools

Antithrombotic pharmacotherapy

• Elective PCI
• Non-St-segment elevation ACS
• ST-segment elevation myoacardial infraction
• Points of interest and special conditions

Secondary prevention

• Background and rationale
• Modalities
• Settings

Strategies for follow-up