New ESC/EACTS guidelines on myocardial revascularisation Indications for coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention.

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Presentation transcript:

New ESC/EACTS guidelines on myocardial revascularisation Indications for coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in stable patients Indications for coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in stable patients Indications for revascularisation in stable angina or silent ischemia Indications for revascularisation in stable angina or silent ischemia

New ESC/EACTS guidelines on myocardial revascularisation Indications for coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in stable patients with lesions suitable for both procedures and low predicted surgical mortality Subset of CAD by anatomy Favours CABG Favours PCI IVD or 2VD – non proximal LADIIb CI C IVD or 2VD –proximal LADI AIIa B 3VD simple lesions, full functional revascularization achievable with PCI, SYNTAX, score  22 I AIIa B 3VD simple lesions, full functional revascularization achievable with PCI, SYNTAX, score >22I AIII A Left main (isolated or IVD, ostium/shaft)I AIIa B Left main (isolated or IVD, distal bifurcation)I AIIb B Left main + 2VD or 3VD, SYNTAX score  32 I AIIb B Left main + 2VD or 3VD, SYNTAX score  33 I AIII B VD=vessel disease; CABG = coronary artery bypass grafting; CAD = coronary artery disease; LAD = left anterior descending; PCI = percutaneous coronary intervention. Table provides an information on the level of evidences from the clinical trials and/or meta- analyses in favour of CABG or PCI according to the anatomical localisation of the disease ESC/EACTS GUIDELINES. Eur Heart J. Doi: /eurheatj/ehq277 Level of proof:>>

Indications for revascularisation in stable angina or silent ischemia Subset of CAD by anatomy Class of recommendation Level of evidence For prognosis Left main >50% IA Any proximal LAD >50% IA 2VD or 3VD with impaired LV function IB Proven large area of ischaemia (>10% LV) IB Single remaining patent vessel >50% stenosis IC IVD without proximal LAD and without >10% ischaemia IIIA For symptoms Any Stenosis >50% with limiting angina or angina equivalent, unresponsive to OMT IA Dyspnoea/CHF and >10% LV ischaemia/variability supplied by <50% stenotic artery IIaB No limiting symptoms with OMT IIIC CAD = coronary artery disease; CHF = chronic heart failure; FFR = fractional flow reserves; LAD = left anterior descending; LV = left ventricle; OMT = optimal medical therapy; VD = vessel disease New ESC/EACTS guidelines on myocardial revascularisation ESC/EACTS GUIDELINES. Eur Heart J. Doi: /eurheatj/ehq277 Level of proof: > >