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2018 ESC Clinical Practice Guidelines in the spotlight - Myocardial Revascularization

ESC Congress News 2018 - Munich, Germany

The 2018 ESC/EACTS Guidelines on Myocardial Revascularization(1) feature some very interesting updates on knowledge that will impact clinical practice, thinks Doctor David Glineur (The Ottawa Heart Institute, Ottawa, Ontario, Canada), Review Coordinator for these guidelines along with Professor William Wijns.

Coronary Artery Disease (Chronic)
Cardiovascular Surgery
Acute Coronary Syndromes

David-Glineur-esc-congress-news-2018.jpgOne of the most notable changes in this latest update, the one that really stands out for Dr. Glineur, concerns diabetic patients. “Previously, a doctor’s decision about whether to use a coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) was made almost exclusively on an individual patient basis. However, sufficient data have now accumulated to confirm that patients with diabetes form a distinct group and that coronary surgery is the best approach to ensure a good long-term outcome for these individuals, even in those with a low SYNTAX score.”

“The finding that revascularisation technique can be guided by diabetic status is completely new and provides clinicians with a rapid way of selecting the optimum method for certain patient groups.”

The use of multiple-artery CABG is another of Dr. Glineur’s highlights. “The bulk of the latest scientific evidence favours the use of multipleartery grafting, commonly using the radial artery and left internal mammary artery, over single-artery approaches, and the endorsement of this approach is approaching a grade IB recommendation,” he explains. Dr. Glineur is also happy to report that the role of a multidisciplinary heart team in management is high on the list of recommendations. “This was first proposed in 2014,” he says, “but features much more prominently in the latest guidelines. I think it is really important that we continue to recognise this as being fundamental to optimising patient care. As an example, in elective revascularisation procedures, the use of ad hoc PCI is increasingly being regarded as unjustifiable in the setting of stable coronary disease with intermediate or high SYNTAX score, and treatment decisions, based on the best evidence set out in treatment guidelines, should consider input from all team members.” What are the other major or significant changes? “In terms of preprocedural examinations, the 2018 guidelines give more weight to the use of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) as new tools to help in the assessment of coronary artery stenosis severity,” says Dr. Glineur, “although the visual inspection of coronary stenosis remains a standard approach.”

Regarding devices, he comments, “We have seen a real decline in evidence to support the implantation of resorbable drug-eluting stents. A move to reduce their use was proposed in the previous guidelines and this advice is strengthened in the latest version, to the extent that, wherever possible, the use of these types of stent should be avoided.”

Dr. Glineur is proud of the latest myocardial revascularisation guidelines and wants to express his thanks to the large team of committed individuals involved in putting them together. “This is a gruelling task! Until I became involved in the guidelines, I had no idea about the time and intellectual demands required to produce them,” he confesses. However, the result is a series of guidelines that are based on the very latest scientific evidence and that are subject to rigorous expert review. “The ESC/EACTS Guidelines are probably the most frequently used of those available. Part of this is, of course, due to the high quality of the content. However, it is the fact that they are clear and easy to use that really sets them apart from other guidelines and makes them the guidelines of choice in clinical practice settings around the world.”

1. 2018 ESC/EACTS Guidelines on Myocardial Revascularization. Eur Heart J 2018. doi:10.1093/eurheartj/ehy394.


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Notes to editor

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2018

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2018 takes place 25 to 29 August at the Messe München in Munich, Germany. Explore the scientific programme