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 www.cardiotimes.com 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