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New ESC/EACTS guidelines on myocardial revascularisation
• Indications for coronary artery bypass grafting (CABG) vs.
percutaneous coronary intervention (PCI) in stable patients
• Indications for revascularisation in stable angina or silent ischemia
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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
Favours
CABG
Favours PCI
IIb C
IC
IVD or 2VD –proximal LAD
IA
IIa B
3VD simple lesions, full functional revascularization achievable with PCI, SYNTAX, score  22
IA
IIa B
3VD simple lesions, full functional revascularization achievable with PCI, SYNTAX, score >22
IA
III A
Left main (isolated or IVD, ostium/shaft)
IA
IIa B
Left main (isolated or IVD, distal bifurcation)
IA
IIb B
Left main + 2VD or 3VD, SYNTAX score  32
IA
IIb B
Left main + 2VD or 3VD, SYNTAX score  33
IA
III B
Subset of CAD by anatomy
IVD or 2VD – non proximal LAD
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 metaanalyses in favour of CABG or PCI according to the anatomical localisation of the disease
Level of proof:
>
www.cardiotimes.com
>
ESC/EACTS GUIDELINES. Eur Heart J. Doi:10.1093/eurheatj/ehq277
New ESC/EACTS guidelines on myocardial revascularisation
Indications for revascularisation in stable angina or silent ischemia
Class of
recommendation
Level of
evidence
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
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
Subset of CAD by anatomy
For
prognosis
For
symptoms
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
Level of proof:
www.cardiotimes.com
>
ESC/EACTS GUIDELINES. Eur Heart J. Doi:10.1093/eurheatj/ehq277