ESC/EACTS Guidelines on Myocardial Revascularization

Table of contents

1. Preamble

2. Introduction

2.1 What is new in the 2018 Guidelines?

3.Diagnostic tools to guide myocardial revascularization

3.1 Non-invasive diagnostic tools

3.2 Invasive diagnostic tools

3.3 Gaps in the evidence

4. Process for decision-making and patient information

4.1 Patient information and informed consent

4.2 Multidisciplinary decision-making (Heart Team)

4.3 Timing of revascularization

5. Revascularization for stable coronary artery disease

5.1 Rationale for revascularization

5.2 Evidence basis for revascularization

5.3 Percutaneous coronary intervention vs. coronary artery bypass grafting

5.4 Gaps in the evidence

6. Revascularization in non-ST-elevation acute coronary syndrome

6.1 Early invasive vs. conservative strategy

6.2 Timing of angiography and intervention

6.3 Type of revascularization

6.4 Gaps in the evidence

7. Revascularization in ST-segment elevation myocardial infarction

7.1 Time delays

7.2 Selection of reperfusion strategy

7.3 Primary percutaneous coronary intervention

7.4 Percutaneous coronary intervention after thrombolysis and in patients with late diagnosis

7.5 Gaps in the evidence

8. Myocardial revascularization in patients with heart failure

8.1Chronic heart failure

8.2 Acute heart failure and cardiogenic shock

8.3 Gaps in the evidence

9. Revascularization in patients with diabetes

9.1 Evidence for myocardial revascularization

9.2 Type of myocardial revascularization

9.3 Revascularization with the use of percutaneous coronary intervention

9.4 Antithrombotic pharmacotherapy

9.5 Metformin

9.6 Gaps in the evidence

10. Revascularization in patients with chronic kidney disease

10.1 Evidence base for revascularization and recommendations

10.2 Prevention of contrast-induced nephropathy

10.3 Gaps in the evidence

11. Revascularization in patients requiring valve interventions

11.1 Primary indication for valve interventions

11.2 Primary indication for myocardial revascularization

11.3 Gaps in the evidence

12 .Associated peripheral artery diseases

12.1 Prevention of stroke associated with carotid artery disease and myocardial revascularization

12.2 Associated coronary and peripheral artery diseases

13. Repeat revascularization and hybrid procedures

13.1 Early graft failure

13.2 Acute percutaneous coronary intervention failure

13.3 Disease progression and late graft failure

13.4 Repeat percutaneous coronary intervention

14. Arrhythmias

14.1 Ventricular arrhythmias

14.2 Atrial arrhythmias

14.3 Gaps in the evidence

15. Procedural aspects of coronary artery bypass grafting

15.1 Surgical techniques

15.2 Reporting perioperative outcomes

15.3 Gaps in the evidence

16. Procedural aspects of percutaneous coronary intervention

16.1 Percutaneous coronary intervention devices

16.2 Invasive imaging tools for procedural guidance

16.3 Specific lesion subsets

16.4 Vascular access

17. Antithrombotic treatments

17.1 Percutaneous coronary intervention in stable coronary artery disease

17.2 Non-ST-segment elevation acute coronary syndrome

17.3 ST-segment elevation myocardial infarction

17.4 Coronary artery bypass grafting

17.5 Special conditions

17.6 Gaps in the evidence

18 .Volume–outcome relationship for revascularization procedures

18.1 Coronary artery bypass grafting

18.2 Percutaneous coronary intervention

18.3 Training in cardiac surgery and interventional cardiology for myocardial revascularization

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

19.1 Gaps in the evidence

20. Key messages

21. Evidence-based “to do” and “not to do” messages from the Guidelines

Appendix

References