Multivessel and left main disease: indications for surgical and percutaneous intervention

Stockholm, Sweden, 29 August: Multivessel and left main disease have been long considered as mainstay indications for coronary artery bypass grafting surgery (CABG).  This recommendation, however, has been strongly challenged on several occasions. The release of new Myocardial Revascularisation guidelines by ESC and the European Association of Cardio-Thoracic Surgeons (EACTS) at the ESC Congress on Sunday 29 August is likely to shed new light on what has become a controversial topic. 

As recently as 2009, the American College of Cardiology issued its Appropriateness Criteria for Coronary Revascularization document (ACCR) in which both multivessel and left main disease subsets are considered surgical indications – and therefore appropriate for CABG – rather than indications for percutaneous coronary intervention (PCI) using stents. The ACCR document suggests that PCI is inappropriate for left main disease and uncertain for multivessel disease.

Doctor William Wijns of the OLV Hospital in Aalst, Belgium was Co-Chair of the ESC/EACTS Task Force that prepared the new guidelines. He believes that the deep insight gained while reviewing the available evidence and developing the guidelines will give better information and guidance on the issue of when to use CABG and PCI for multivessel and left main disease. “There is some evidence to suggest that we should revisit established practice and review the recommendations contained in the ACCR,” he said. “The new guidelines we have written represent, for the first time, consensus opinion between clinical-non interventional cardiologists, interventional cardiologists and cardiac surgeons.”

The new Myocardial Revascularisation Guidelines are the result of co-operation between the ESC and EACTS.  They were written by a Task Force of 25 experts made up of surgeons and cardiologists drawn from both organisations.  The Task Force was jointly led by Doctor Wijns and Professor Philippe Kolh of EACTS, and copies of the guidelines can be downloaded at http://authors.escardio.org/guidelines-surveys/esc-guidelines.