ESC/EACTS Publish Guidelines on Myocardial Revascularization
August 28, 2018—The European Society of Cardiology (ESC) announced the publication of new ESC/European Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularization. The guidelines are available online in European Heart Journal and on the ESC website. The guidelines were announced at the ESC Congress 2018 held August 25–29 in Munich, Germany.
According to ESC, the guidelines advise that patients should be involved in choosing the procedure. Patients need unbiased, evidence-based information with terminology they can understand explaining the risks and benefits in the short- and long-term such as survival, relief of chest pain, quality of life, and the requirement for a repeat procedure. Additionally, in nonemergency situations, patients must have time to reflect on the trade-offs and seek a second opinion. Patients have the right to obtain information on the level of experience of the doctor and hospital in performing these procedures.
Additionally, a heart team of cardiologists, cardiac surgeons, and anesthetists should be consulted for patients with chronic coronary artery disease (CAD) and a complex coronary anatomy, while respecting the preferences of the patient.
As noted in the society's announcement, outcomes from the two procedures vary according to the anatomic complexity of CAD, graded using the SYNTAX score, with surgical bypass and percutaneous coronary intervention (PCI) providing similar long-term outcomes for patients with more simple disease. For patients with complex disease, long-term survival is better with surgical bypass. Patients with diabetes have better long-term outcomes with surgical bypass even if they have less complex disease.
In patients with stable disease, the procedure should be chosen that is most likely to achieve complete revascularization, which improves symptoms and survival. When PCI is chosen, drug-eluting stents should be used. Bioresorbable stents should only be used in clinical trials, advised the guidelines.
Professor Miguel Sousa-Uva, MD, who is EACTS Chairperson of the Guidelines Task Force, commented in the announcement, "Despite the development of new stents, studies show that patients with complex CAD have better survival with bypass surgery and this should be the preferred method of revascularization."
Professor Franz-Josef Neumann, ESC Chairperson of the Guidelines Task Force, stated, "The guidelines aim to help patients and doctors make a logical decision on the type of revascularization based on the scientific evidence. They will also be consulted by governments and health insurers as the standard of care for coronary artery disease."