New ESC/EACTS guidelines on myocardial revascularisationNew ESC/EACTS guidelines on myocardial revascularisation

• Indications for coronary artery bypass grafting (CABG) vs. Indications for coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in stable patientspercutaneous coronary intervention (PCI) in stable patients

• Indications for revascularisation in stable angina or silent ischemiaIndications for revascularisation in stable angina or silent ischemia

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New ESC/EACTS guidelines on myocardial revascularisationNew ESC/EACTS guidelines on myocardial revascularisation

Indications for coronary artery bypass grafting (CABG) vs. percutaneous coronary Indications for coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in stable patients with lesions suitable for both procedures and low intervention (PCI) in stable patients with lesions suitable for both procedures and low

predicted surgical mortalitypredicted surgical mortality

Subset of CAD by anatomySubset of CAD by anatomy Favours Favours CABGCABG

Favours PCIFavours PCI

IVD or 2VD – non proximal LAD IIb C I C

IVD or 2VD –proximal LAD I A IIa B

3VD simple lesions, full functional revascularization achievable with PCI, SYNTAX, score 22 I A IIa B

3VD simple lesions, full functional revascularization achievable with PCI, SYNTAX, score >22 I A III A

Left main (isolated or IVD, ostium/shaft) I A IIa B

Left main (isolated or IVD, distal bifurcation) I A IIb B

Left main + 2VD or 3VD, SYNTAX score 32 I A IIb B

Left main + 2VD or 3VD, SYNTAX score 33 I A III BVD=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-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 diseaseanalyses in favour of CABG or PCI according to the anatomical localisation of the disease

ESC/EACTS GUIDELINES. Eur Heart J. Doi:10.1093/eurheatj/ehq277

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Indications for revascularisation in stable angina or silent ischemiaIndications for revascularisation in stable angina or silent ischemia

Subset of CAD by anatomySubset of CAD by anatomy Class of Class of recommendationrecommendation

Level of Level of evidenceevidence

For prognosis

Left main >50% I A

Any proximal LAD >50% I A

2VD or 3VD with impaired LV function I B

Proven large area of ischaemia (>10% LV) I B

Single remaining patent vessel >50% stenosis I C

IVD without proximal LAD and without >10% ischaemia III A

For symptoms

Any Stenosis >50% with limiting angina or angina equivalent, unresponsive to OMT

I A

Dyspnoea/CHF and >10% LV ischaemia/variability supplied by <50% stenotic artery

IIa B

No limiting symptoms with OMT III C

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 revascularisationNew ESC/EACTS guidelines on myocardial revascularisation

ESC/EACTS GUIDELINES. Eur Heart J. Doi:10.1093/eurheatj/ehq277www.cardiotimes.com

Level of proof: > >