The European Society of Cardiology (ESC) and the European Association for Cardiothoracic Surgery (EACTS) have collaborated on reviewing the evidence for the treatment of low surgical-risk patients with left main coronary artery disease. The review, authored by a panel chaired by Professors Robert Byrne and Stephen Fremes, was published today in the European Heart Journal and the European Journal of Cardio-Thoracic Surgery.
The expert group’s conclusion, after a comprehensive review of all relevant evidence, is that for low-surgical risk patients, both coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) are clinically reasonable based on patient preference, available expertise, and local operator volumes. They have advised that in future guidelines the class of recommendation and level of evidence for CABG should be Class I and Level of Evidence A, whilst for PCI it should be Class IIa and Level of Evidence A. Their report and associated materials are now being considered by the Task Force working on a new guideline for Chronic Coronary Syndromes, scheduled for publication in August 2024. Until then, the ESC and EACTS believe that that local Heart Teams should consider both the current (2018) guidelines and the findings of the expert group when discussing the management of patients with stable coronary artery disease.